Webinar: Employment and Epilepsy (Request Recording) - Epilepsy Foundation of Minnesota

First Name

Last Name

Email

Phone

Zip Code

Organization/Employer

Industry Type

Please specify:

What is your relationship to epilepsy?

I have epilepsy/seizuresMy child has epilepsy/seizuresMy parent has epilepsy/seizuresMy spouse or partner has epilepsy/seizuresAnother family member has epilepsy/seizuresI lost someone who had epilepsyA friend/co-worker has epilepsy/seizuresI work with people who have epilepsy/seizuresOther/prefer not to respond

Is this your work email?

Email listed above

Work Email

Demographic Information

EFMN is asking demographic questions to have a better understanding on who we serve. Although all questions are required, there is always a "Prefer not to answer" option if you choose to keep this information private.

The options for demographic questions are in accordance to the US Census Bureau.

Gender

Race

Ethnicity

How did you hear about this webinar?

Staff Member Name

Resources