Membership Application

Epilepsy Alliance America is growing!  We are actively seeking new Member Organizations.
For questions about becoming a Member Organization, or about the application process, please reach out to Lisa Gallipoli, COO, at

You can complete and submit the application form below.
If you are having any challenges submitting the documents necessary, please email us for assistance.
There is a size limit for documents uploaded to the site.



    Organization is a registered 501c(3)
    Please upload the previous (2) years of Form 990 (PDF)


    In applying to become a Member Organization of Epilepsy Alliance America, the above-name organization, confirms that it meets the following criteria:

    • Activities and goals of the organization are focused on supporting people affected by epilepsy and/or seizure disorders;
    • The organization is formally organized with a written constitution and/or Bylaws as a 501c3 organization;
    • The organization has a Constitution and/or Bylaws which do not conflict with that of the Epilepsy Alliance America.