Assistance Request for: <span style="font-size:11.0pt;font-family:&quot;Arial&quot;,sans-serif; mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;mso-ansi-language: EN-US;mso-fareast-language:EN-US;mso-bidi-language:AR-SA">Vista Queen Pizza Cruise 8/23/2018&nbsp;</span>

The person responsible for this form has provided the following contact information:

1600 University Avenue West, Suite 300  |  St. Paul, MN 55104  |  1.800.779.0777  |  epilepsy@efmn.org