YES! I would like to go Purple for Purple Day! Here is what I'll be doing to show my support... Please tick the activities you are planning to do. In some instances a member of our Fundraising Team may contact you for further information. Purple Day support * Host my own Purple Day fundraising activity or event at work or school or play for Epilepsy Queensland (and go in the draw for lots of great prizes!) Become a Purple Day Hero and set up my own fundraising page at www.epilepsyqueensland.com.au/purple-hero Buy or sell Purple Day merchandise on behalf of Epilepsy Queensland as per order form Approval conditions apply Display an Epilepsy Queensland collection tin at my place of work Encourage my local pharmacies GPs schools shops and businesses to get involved and will advise Epilepsy Queensland accordingly of their agreement I am happy to be contacted by the media regarding my Purple Day involvement I would like to help promote the Purple Pledge Project Other please specify below If Other please specify I wish to register as * Individual Business or workplace Purple Pharmacy Retailer Other If Other please specify My details * - Select -MrMrsMsDr First Name * Surname * Business Street Address * Suburb / Town * State * Postcode * Telephone * Fax Mobile Email * I have a connection with epilepsy (please specify) (optional) Why have they chosen to fundraise for Epilepsy Queensland? How did they hear about Purple Day with Epilepsy Queensland?