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Adult Connect Group

June 26 @ 6:30 pm - 7:30 pm

« Spanish Connect Group

Adults living with epilepsy come together to meet others, share the triumphs and challenges of living with seizures and connect with those who understand the epilepsy journey. For more information, please contact Lisa Necastro at Lisa.necastro@efmn.org or 651-287-2358 Zoom Link: https://us02web.zoom.us/j/82737424010?pwd=bDRmTmtTTjg1N1RJQXB0ZXpmc0pUZz09

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Details

Date:: June 26
Time:: 6:30 pm - 7:30 pm
Event Category:: Virtual
Event Tags:: Connect Groups

Venue

Virtual Event via Zoom Meeting

RSVP

Adult Connect Group 06/26/2025

Disclaimer: HIPAA (Health Insurance Portability and Accountability Act) sets standards for protecting the privacy and security of health information. This registration form is not HIPAA compliant and should not be used to submit protected health information (PHI).

First Name

Last Name

Email

Phone

Preferred Contact Method

EmailPhoneText

Emergency Contact

We are collecting Emergency Contact information for these events. Should a seizure or other medical situation arise for you during the group time, we need to have access to an emergency contact, and your physical location address. This information is not shared outside of EFMN staff unless they need to contact EMS services to respond to your home to provide medical care.

First Name

Last Name

Relationship

Phone

Have you participated in an EFMN Connect Group this year?

YesNo

Please list the date of the most recent Connect Group you attended.

Additional Information

Date of Birth

Street Address

City

State

Zip Code

5-Digit Zip Code Calculation

What is your primary relationship to epilepsy?

Has Epilepsy (Self)Another Family Member Has EpilepsyChild Has EpilepsyFriend/Co-Worker Has EpilepsyLost Someone with EpilepsyParent Has EpilepsySpouse or Partner Has EpilepsyWorks with People with EpilepsyOther / Prefer Not to Answer

Gender

Race

Ethnicity

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.

Please read the statements below and select the one that applies.

I consent to receive SMS text communications from the Epilepsy Foundation of Minnesota (EFMN) at the phone number provided above. I understand that messaging frequency may vary, and message & data rates may apply. Reply STOP to opt out of SMS text messages at any time.I do not consent to receive SMS text communications from the Epilepsy Foundation of Minnesota at the phone number provided above.

« Spanish Connect Group

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