Register for A Day of Hope

Registration is a two-part process:

  1. Complete and submit the registration form below, being sure to include all requested information.
  2. After you submit this form, you will be sent to our secure payment page where you can pay your conference registration fee with your Visa or Mastercard. The registration fee is $15 per person or $50 per family of 4 or more.

If you have questions, please contact us at (800)221-2689 or sgodwin@epilepsyheartland.org.

Name:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
E-mail:
Please list the names of other adults who will be attending with you
Please list the names and ages of children and teens who will be attending with you
Which conference will you be attending?
Coralville, IA Omaha, NE
Breakout Sessions: Adults, please choose one morning and one afternoon session. Indicate how many adults will be attending each session.
Morning: Please indicate the number of adults who will be attending Ask the Epileptologist Q&A
Morning: Please indicate the number of adults who will be attending Epilepsy & the Rest of the Family
Afternoon: Please indicate the number of adults who will be attending School Planning & Epilepsy
Afternoon: Please indicate the number of adults who will be attending New Horizons In Research & Treatment
After you submit your registration, you will be returned to this page. Use the "Payment" link at the top of the page to pay securely online.