Online Beyond Epilepsy Youth Conference Registration

Beyond Epilepsy Youth Conference Virtual Registration

27th & 28th April 2024

By registering, you are accepting our privacy terms: https://www.epilepsy.org.au/epilepsy-action-legal-privacy-policy/

Please register for the Beyond Epilepsy Youth Conference and provide your details below. Don't hesitate to contact us at epilepsy@epilepsy.org.au if you have any questions. You will receive the presentation link prior to the event.

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* 1. Name

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* 2. Date of birth

DOB

Date

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* 3. Email

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* 4. Street Address

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* 5. State

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* 6. Postcode

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* 7. Have you been diagnosed with epilepsy?

Yes

Unsure

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* 8. Would you like to subscribe to our quarterly epilepsy newsletter, E360?

Yes

Online Beyond Epilepsy Youth Conference Registration

Question Title

* 1. Name

Question Title

* 2. Date of birth

Question Title

* 3. Email

Question Title

* 4. Street Address

Question Title

* 5. State

Question Title

* 6. Postcode

Question Title

* 7. Have you been diagnosed with epilepsy?

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* 8. Would you like to subscribe to our quarterly epilepsy newsletter, E360?

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* 9. How did you hear about the conference?