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.