BECOME A MEMBER ORGANIZATION

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 lisa.gallipoli@epilepsyallianceamerica.org.

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.

    CONTACT INFORMATION

    TAX INFORMATION

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

    GENERAL INFORMATION

    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.