Share Your Story | Epilepsy Foundation of Michigan


	Search:

Share Your Story

Please fill in the information below to share your story with our foundation.
First Name:	*
Last Name:	*
Address:	*
Address 2:
City:	*
State:	*
Zip Code:	*
Phone Number:
Email Address:	*
How did you hear about us:

In 500 words or less, please describe your experience with seizure disorders:


Are you interested in receiving information regarding our programs and services:


If yes, how would you like to receive your information:


Select Your Interest:
Adult Programs Youth/Family Programs Special Events Newsletter

Quick Links


Copyright © 2008 \| The Epilepsy Foundation of Michigan	Privacy Policy \| Contact Us \| Site Map
Southfield Office: 20300 Civic Center Dr. Ste 250, Southfield, MI 48076 \| Phone: (248) 351-7979
Grand Rapids Office: 1345 Monroe Ave NW, Suite 202, Grand Rapids, MI 49505 \| Phone:(616) 454-7979

Non Profit Web Design by Morton Marketing Inc.


Copyright © 2008 \| The Epilepsy Foundation of Michigan	Privacy Policy \| Contact Us \| Site Map
Southfield Office: 20300 Civic Center Dr. Ste 250, Southfield, MI 48076 \| Phone: (248) 351-7979
Grand Rapids Office: 1345 Monroe Ave NW, Suite 202, Grand Rapids, MI 49505 \| Phone:(616) 454-7979

Non Profit Web Design by Morton Marketing Inc.