Fundraising Registration Form

Thanks for choosing to fundraise for Epilepsy Action by holding a fundraising event. Please complete the information below. Note that fields marked with an asterisk (*) are mandatory. Once your registration has been approved you will receive an Authority to Fundraise letter – then you can start fundraising!

Fundraiser Contact Details

  • Full name of the person organising the fundraising event *

  • Fundraising Event Details

  • How much money do you plan to raise for Epilepsy Action? (Please estimate)*
  • How much will your fundraising activity/event cost to run? (Please estimate)*
  • If you have a promo code please enter it here, otherwise leave it blank.
  • Terms and Conditions
    * I/We have read Epilepsy Action Australia’s Fundraising Guidelines and I/we agree to conduct my/our fundraising activity/event in accordance with these guidelines and in a manner which upholds the integrity, principles and values of Epilepsy Action Australia.
    * I/We acknowledge that I/we am in proper physical and mental condition to organise and conduct the fundraising activity/event and have considered and voluntarily agree to any and all risks associated with conducting the event.
    * I/We understand that I/we cannot make a claim against Epilepsy Action Australia nor can Epilepsy Action Australia and all its staff be held responsible for, any damage, loss or injury incurred as a direct or indirect result of the fundraising activity/event outlined in this agreement.
    * I/We understand that any images sent to Epilepsy Action Australia or posted publicly to any Epilepsy Action Australia social media channel from my/our fundraising activity/event may be used for promotional purposes by Epilepsy Action Australia.

We acknowledge the Traditional Owners of the land where we work and live. We pay our respects to Elders past, present and emerging.

We celebrate the stories, culture and traditions of Aboriginal and Torres Strait Islander Peoples of all communities who also work and live on this land.

Important Message: This information is not intended as medical advice. Do not make changes to treatment or medications without first discussing with your treating clinician.