The Epilepsy Association of Calgary

Thursday, November 17, 2011

Use the form below to register online or download printable registration form and fax or mail it to the office!

* Participant's Name:
* Address:
* City:
* Province:
* Postal Code:
* Telephone Number:
* E-mail Address:
* My FUNd-Raising Goal for the Bare Naked Noggins Head Shave is $
Funds are raised via pledges from friends and family. Donations can be made online here, submitted on a printable pledge form or by calling the Epilepsy Association at 403-230-2764.
Submit your photo: (JPG, PNG, or GIF format only - maximum file size 700 Kb)
If your photo is greater than 700Kb or a different file type, you can send an e-mail to the website admin and they can manually add it to your profile.
* Tell us why you'd like to shave your head for epilepsy:
I am over 18 years of age
I am under 18 years of age
* Please note: ALL participants are required to complete a consent form and fax to the office at 403-230-5766. Those under the age of 18 will need a parent or guardian to complete and submit their child's Consent Form. This is required in order to participate in the headshave, be photographed by media, EAC and/or others at the event, and have photos posted on our website and/or newsletter. Download Consent Form (PDF) or contact our office for a copy.

Note: Only the participant's name, photo, monetary goal, and reason for participating will appear on our Bare Naked Noggins website; all other information is for office use.

Participant Profiles:

Lead Sponsors: