Registration Merchandise Form

Item Cost Quantity Total $

Retail Display Box—contains 12 wristbands, 4 ‘e’ ribbons, 2 keyrings, 10 pens, 4 badges, 4 shoelaces, 2 shopping bags, 1 bear, 2 turtles and 1 cooler bag $175.00

$1 Silicone Embossed Wristband 040 $1.00

$2 ‘e’ Ribbon 046 $2.00

$5 Keyring 004 $5.00

$5 Crystal Pen 049 $5.00

$5 Purple Plush Bear 043 $5.00

$5 Purple Plush Dino 067 $5.00

$5 Purple Shoelace pair NEW! 078 $5.00

$5 Folding Shopping Bag NEW! 072 $5.00

$5 Lipbalm NEW!* 076 $5.00

$10 Charm Bracelet 071 $10.00

$10 Purple Plush Turtle NEW! 079 $10.00

$10 Bucket Hat NEW!* 074 $10.00

$15 Baseball Cap NEW!* 073 $15.00

$20 Cooler Bag NEW! 077 $20.00

$20 Water bottle NEW!* 075 $20.00

Plus postage and handling on all orders less than $50 100 $11.00 GST Inc

Mr/Mrs/Ms/Dr First Name: Surname:

Business Name:

Street Address:

Suburb: Postcode: Telephone:

Email: Amount $

Credit Card: Visa Mastercard Card Number:

Cardholder’s Name: Signature: Expiry Date:

Epilepsy Queensland IncPO Box 1457, Coorparoo DC QLD 4151

Ph 07 3435 5000 or 1300 852 853 (outside Brisbane) Fax 07 3435 5025

Email purple@epilepsyqueensland.com.au www.epilepsyqueensland.com.au

ABN 42 025 269 961

YES! I will GO PURPLE for epilepsy! Please tick the activities you are planning to do.

Wear purple

Make a donation

Post or share on social media

Host my own Purple Day fundraising activity/event

Display an Epilepsy Queensland collection box

I am happy to be contacted by the media to share my story

Sell our exciting retail range on consignment. (sale or return basis, pre-payment not required, conditions apply) Please complete your order below *indicates new items not included in the retail box

Become a Purple Day Hero and set up my own fundraising page at www.epilepsyqueensland.com.au/purple-hero

Proudly sponsored by:

Prices correct at time of printing

Shop securely online: www.epilepsyqueensland.com.au/shopor complete your order form and return to purple@epilepsyqueensland.com.au

Epilepsy Queensland IncPO Box 1457, Coorparoo BC QLD 4151

Ph 07 3435 5000 or 1300 852 853 (outside Brisbane) Fax 07 3435 5025

Email purple@epilepsyqueensland.com.au www.epilepsyqueensland.com.au

ABN 42 025 269 961

Silicone Embossed Wristband

$1

‘e’Ribbon

$2

Keyring

$5

Crystal Pen

$5

Plush Dino (26cm)

$5

Plush Bear (18cm)

$5

Shoelaces

$5

Folding Shopping Bag

$5

Lipbalm

$5

Charm Bracelet

$10

Plush Turtle

$10

Bucket Hat

$10

Baseball Cap

$15

4.2L Cooler Bag (W:24cm)

$20

Water Bottle

$20

ARTWORK DIGITAL MOCKUP

Please check artwork carefully: Please check this approval carefully for errors and omissions. Care is taken to ensure that the artwork is correct, however errors that pass this stage are the customers responsibility. Your signature constitutes acceptance of full responsibility for any errors or omissions. The digital mock up included in this approval is a low resolution representation of the finished product only, for accurate detail please refer to the artwork section of the form. Once satisfied, sign and fax to 02 6280 9966.Account Manager: Lindsey Davie

Artwork Approval

Purple ‘e’ ribbonPurple satin ribbon with butterfly clasp pin.Silver plated ‘e’ clasp on front.

Artwork is correct. Proceed with production. Alterations/corrections required.

Approved by: Signed: Date:

Did you know?10% of Australians will have a seizure during their lifetime, while 3-4% will be diagnosed

with epilepsy.

Epilepsy is the world’s most common serious brain disorder.

Epilepsy can occur at any age.

Stigma, discrimination and misconceptions about epilepsy are sometimes worse than the

condition itself.

FOR MORE INFORMATIONCall 1300 852 853 or visit

www.epilepsyaustralia.net

EPILEPSY AUSTRALIAthrough its state-based member organisations provides vital support services and information

to people with epilepsy and their families.

THANK YOU FOR YOUR SUPPORTEPILEPSY AUSTRALIA

National coalition of state-based epilepsy organisations

www.epilepsyaustralia.net1300 852 853

Purple Dayfor Epilepsy

$3

PURPLE DAY FO

R EPILEP

SY

1300 852 853

ARTWORK

DIGITAL MOCKUP

Please check artwork carefully: Please check this approval carefully for errors and omissions. Care is taken to ensure that the artwork is

correct, however errors that pass this stage are the customers responsibility. Your signature constitutes acceptance of full re

sponsibility for

any errors or omissions. The digital mock up included in this approval is a low resolution representation of the finished product only, for

accurate detail please refer to the artwork section of the form. Once satisfied, sign and fax to 02 6280 9966.

Account Manager: Staff Member Name

Artwork Approval

Purple Day PenPurple pen with clear section containing

purple gems. Printed white on two sides.

Artwork

is corre

ct. Pro

ceed w

ith productio

n.

Side 2

Side 1

Alteratio

ns/correc

tions re

quired.

Approve

d by:

Signed:

Date:

Your involvement and support today will change the lives of those living with epilepsy for years to come.

THANK YOU!

Go purple for epilepsy - 26 MarchEpilepsy Queensland’s flagship fundraising event is Purple Day. Part of a global movement, March is our national awareness month. On 26 March each year, people are encouraged to go purple to show their support of those living with epilepsy and to raise funds ensuring our vital services throughout Queensland continue.

Purple Day was founded in 2008 by 9-year-old Cassidy Megan of Canada. Motivated by her own struggles with epilepsy, Cassidy started Purple Day in an effort to tell everyone about epilepsy. She named the day Purple Day after the internationally recognised colour for epilepsy – lavender.

Since then, thousands of individuals, schools and workplaces have joined the campaign, wearing purple and hosting Purple Day events and promotions throughout the month of March.

Proudly sponsored by:

*Prices correct at time of printing