*** SMART Program Registration ***

Thank you for your interest in the Epilepsy Association of Western & Central PA (EAWCP) self-management program that we plan to implement for adults living with epilepsy. All sessions will be held in small groups via Zoom. The 8-week program is lead by a Nurse and Peer Educator who will work with each SMART group to facilitate the education. We ask that those participating make an effort to make it to all 8 sessions.
* First Name
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* Last Name
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* Home Address:
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* County:
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* E-mail:
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* Phone Number:
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* Have you ever participated in an online self-management program? If yes, please explain:
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* How did you hear about this program?
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* Will you be attending with a guest? (If yes, please provide additional information below)
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