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, credit card or by cheque using our postal address (see below).

Your name

Address

Suburb / town

Postcode

Phone

Email

Payment method: Internet BankingCredit CardChequeCash

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: 389011 0669077-00
(Please use first and last name as a reference)

Credit Card (via Givealittle):
https://givealittle.co.nz/donate/org/ewct

Cheque payment:
Please make payable to “Epilepsy Waikato Charitable Trust” and post to
Epilepsy Waikato Charitable Trust
P.O. Box 633
Hamilton 3240