25 DAYS FOR EPILEPSY 2023 CHAMPIONS REGISTRATION Please enable JavaScript in your browser to complete this form.Champion Name *FirstLastName of parent/guardian of younger championFirstLastEmail *Click all that apply: *I am an EEA memberI live in the Edmonton regionI live outside the Edmonton regionI plan to campaign mainly at my schoolI plan to campaign mainly with my family and friendsI plan to campaign mainly in my communityI plan to campaign mainly at workLet us know where you will focus your efforts to spread the word about epilepsy, brain health and the EEA. I agree to have my name (my child's name) posted on the EEA champions' leaders' board page to show progress on the campaign. *Yes, I do.I wish to receive a free ticket for the Saturday, June 24, 2023 party at the Park (Rundle Park) in Edmonton. *Yes, pleaseNo, thank youSubmit
