Online Affiliation

You may use this form to quickly renew your affiliation, please select the appropriate rate using the definitions below.

Complimentary- This rate is for start-up centers in their first year. All others will be subject to cancellation.
Discounted Affiliation- This rate is for centers who are affiliated with another National Affiliation Organization (NIFLA, CareNet, ICU Mobile, Save the Storks, Life Matters Worldwide, International Life Services,, Christian Life Resources, National Christian Adoption Fellowship, National Life Center)
Affiliation- Select this rate if you are not affiliated with another National Affiliation Organization and have been in existence for more than a year.

Please be sure to review and update the organization's information through your Contact Dashboard.

Become an Affiliate

Thank you for your interest in affiliation with Heartbeat International. Please make sure you have reviewed the information about what it means to be a Heartbeat Affiliate, as well as the Committment of Care and Competence before completing your affiliation. Once you complete the online application, we will review your request for affiliation. You will be receive a follow-up email when your affiliation has been approved.

If you have a discount code, enter it here

Membership *

Affiliate - $ 250.00

Affiliate (discounted) - $ 200.00

Affiliate: Complimentary - $ 0.00

Please renew my membership automatically.

Total Amount

Email Address *

Credit Card

If you have a PayPal account, you can click the PayPal button to continue. Otherwise, fill in the credit card and billing information on this form and click Continue at the bottom of the page.

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Card Type

Card Number *

Security Code *

Expiration Date *

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

United States

State/Province *

Postal Code *

Online Affiliation

General Organization Information

Annual Statistics

Services Information

Please provide information about the services offered through this location. Services and hours for satellite locations can be added at a later step.

Please select an "Open" and "Close" time for each day of the week. If closed that day, please select "closed" from the list. If there are exceptions to these times, please indicate these using the "Service Hours Notes" field below.

Please use this space to indicate any availability outside of these hours (i.e. 24 hour hotline), and/or any exceptions to this availability (i.e. closed for lunch 12-1).

Affiliation Agreement

Affiliates of Heartbeat International agree to uphold The Commitment of Care and Competence and Heartbeat Principles. Please click here to review Heartbeat Principles and The Commitment of Care and Competence if needed.