FLAT DONATION || Itching to Scratch: Score a Cure for Epilepsy

FLAT DONATION

Itching to Scratch also offers a simple flat donataion option by filling out the form below.

Select which Epilepsy Foundation/Society you would like to support:

Epilepsy Foundation of Massachuestts & Rhode Island (EFMRI)
Epilepsy Foundation of Florida (EFOF)
British Columbia Epilepsy Society (BCES)

Donation:

Please enter a your donation amount:
$ . 00 (USD)

Contact Information (All fields are required.)

Name First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Email

Confirmation:

You have chosen to make a flat donation of $0.00. Thank You!

You will be contacted directly by the epilepsy organization you've chosen to support in late February/March 2010 with a summary of results, tax deduction information and a request for your donation.