WELCOME
FIRST AID
EVENTS
ESS PROGRAM
HELPFUL LINKS
RESEARCH
SUPPORT GROUPS
KIDS AREA
MEDICATIONS
GALLERY

Registration for the 2011 Winter Gala

Thank you for your interest in helping the Epilepsy Associaton of Utah. After your registration is complete you will be contacted with further information. For upper level registrations we will give you the opportunity to submit your logo for the program.

November 4th, at Noah's in South Jordan, UT
Dinner cost is $100 a plate or a table of 8 for $700

Let your loved one know you think they're a STAR! We are selling gold and silver stars that will be hanging from the walls and ceiling at the dinner. The 16 inch star is $10 the 24 inch star is $20. Dedicate one to your loved one, family members, or friends with epilepsy.

Please fill out the following form.

Attendee Names,
please separate each name
with a comma
Registrant Address
City, State, Zip
Contact Email
Contact Phone
I would like to purchase a star <
List the names you'd like on the stars
please separate each name
with a comma
Total amount of your purchase:

Your contribution is being put to work to assist those with epilepsy to better their lives through education, support and research. Our commitment to you is that we will maintain the quality and effectiveness of this program so that it will continue to merit your support. We vow to provide you with ongoing satisfaction in being part of the fight against epilepsy.

Your gift is tax deductible to the limit permitted by law.
The Epilepsy Association of Utah is a 501(c)(3) charity.


Epilepsy Association of Utah
1995 West 9000 South, Level B | West Jordan, UT 84088
Phone: (801) 566-5949