Epilepsy Action Australia is passionate about raising epilepsy awareness across Australia.
Events like E-Tea, Art for Epilepsy and Purple Day often gain interest from media (newspapers, radio and sometimes TV) and we are asked to provide stories from people with epilepsy and their families to show the public the impact it has on those affected.
We also use people’s stories to fundraise for Epilepsy Action so that we can continue to support people living with epilepsy across Australia.
If you are willing to share your story please fill in the boxes below and tell us a little about yourself or your family. If there is an opportunity to share your story with others we will be sure to let you know!
If you have any questions or concerns, please call our team on 1300 37 45 37.
Your Name (required)
Your Child's name (if applicable)
Your Email (required)
Your Phone Number (required)
Your Suburb (required)
Your State (required)
Your Story (when was the diagnosis, how has it impacted your life, etc)
I give permission for quotations, photographs or visual footage of me and/or my child to appear in fundraising material, media stories, advertisements, fundraising proposals and any material promoting Epilepsy Action and its services.
I agree these quotations, photographs or visual footage can be used by Epilepsy Action Australia for two years.
I understand when Epilepsy Action Australia is publishing information I will be told when and where the information will be published, except in the case of fundraising proposals, which are not made public. Material produced by Epilepsy Action Australia will be read out or shown to me prior to publication.
Epilepsy Action Australia will also describe the materials which will be published or show them to me if this is practicable. This will occur prior to publication.
When the information is being published by print or broadcast media, I will be notified when Epilepsy Action Australia distributes a media release.
I agree to the above statements.
How do you prefer to be contacted?
(Use your Ctrl key to check all that apply)
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