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1.
What is your connection to epilepsy?
Please tick all that apply.
(Required.)
I have epilepsy
I am a family member / carer / friend of someone with epilepsy
I am a healthcare professional
I support the cause but have no direct connection
Other (please specify)
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2.
What is your
membership
status?
(Required.)
I am a standard member
I am a professional member
I
used to be
a member
I have
never been
a member
Not sure
Other (please specify)
3.
Other than membership, have you contributed in any of the following ways to Epilepsy Action?
Please tick all that apply.
Donated money (one-off or regular gift)
Fundraised on behalf of Epilepsy Action
Chosen to leave a legacy donation (in Will)
Volunteered time or skills
Campaigned or raised awareness on behalf of Epilepsy Action
Taken part in research or consultation activities
Shared my personal story to support others or raise awareness
Promoted Epilepsy Action in my community or workplace
Encouraged others to support or get involved
None of the above
Other (please specify)
33%
