My donation is
to protect vital services for people affected by epilepsy
What motivated you to support us today?
How was the money raised?
Which event did you take part in?
Please tick if you are sponsoring someone else
Please give the full name of the person you are sponsoring
Please tick if your fundraising was in memory of someone
Who was it in memory of?
Who is your donation in memory of?
What is their relationship to you? (My mum or friend for example)
Type of celebration?
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Type of celebration
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We can only collect Gift Aid from donations made by individuals.
If you are paying in money from a collection, please leave the Gift Aid box blank
We can only collect Gift Aid from donations made by individuals. If you have raised
money through sponsorship or fundraising, please send us your sponsorship forms so we
can claim the additional Gift Aid.
Please tick the box below if you’d like to Gift Aid your donation.
None of these methods
Ways Epilepsy Action can help me
Ways I can help people affected by epilepsy
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