Email

Name

First Name

Last Name

Website

http://

Name of study

Location of study

Hospital/university, city, anscountry

Epilepsy type(s)

What type of epilepsy is focused on?

Study description

What's the purpose of the study?

Number of people required

Participant payment type and amount

We know you value the expertise of people involved in research!

€/$/£

Date involvement commences

MM

DD

YYYY

Date involvement concludes

MM

DD

YYYY

Any more information

Organisation’s social media handles

Age of those required

Sex of those required

Phone

Country

(###)

###

####

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