Epilepsy Life Source Awareness

ELSA Membership Application

Join Epilepsy Life Source Awareness and help us serve children, adults, veterans, and families living with epilepsy.

$25.00 / month
Monthly Membership
$300.00 lifetime membership
Lifetime Membership

Every donation supports Epilepsy Life Source Awareness and its mission to serve children, adults, veterans, and families living with epilepsy through education, events, advocacy, support services, and community outreach.

1. Member Information

2. What type of member are you?

3. Why would you like to join ELSA?

4. How would you like to help ELSA?

5. How did you hear about ELSA?

6. Communication

How would you prefer ELSA to contact you?

7. Member Agreement

I understand that by submitting this form, I am requesting membership with Epilepsy Life Source Awareness. I agree to support the mission and goals of the organization and to follow applicable ELSA membership guidelines.