Membership application and
donation form

We welcome your application to become a member of EWCT though this online form. Membership will enable EWCT to provide you, and others who have epilepsy, and your family/support people, with informational resources and social contact for more fulfilling lives. Membership is free, but we welcome donations to EWCT which can be made using internet bank transfer or credit card (see below).

    Your name

    Address

    Suburb / town

    Postcode

    Phone

    Email

    Payment method: Internet BankingCredit CardCash

    Amount: $5$10$20$25 & over
    Donations of $5 or more are tax deductible. Payment details below.

    Comments

    Payment details for donations:

    Bank transfer:
    Bank: Kiwibank
    Name: Epilepsy Waikato Charitable Trust
    Account: 389019 0853493-00
    (Please use first and last name as a reference)

    Credit Card (a link to PayPal will open):
    https://www.paypal.com/donate/?hosted_button_id=437QKHT5MCZR4