Application for International Affiliation and Renewal

International Affiliate Application

Thank you for considering becoming part of the Heartbeat International family. If you are already an affiliate and would like to renew your affiliation, please return to the Home page and login using your username and password. The cost for International Affiliation is $70 USD. If you would like to request a complimentary affiliation as an existing affiliate, please contact efoell@heartbeatinternational.org first before proceeding with the renewal application. Please be sure to update your organizations information through your contact dashboard. 

 
Total Amount
International Affiliation
Unless this is a brand new organization, be sure to choose "Select existing organization". Begin typing the organization's name and select your organization from the list that appears.
Please provide the address you receive mail at:
Please provide the physical address of your organization.
When entering your hours of operation, please use the M T W Th F Sat Sun to indicate days and include a/p to indicate open hours (i.e. MWF 8a-8p; TTh 7a-9p)
Please indicate if you offer services in languages other than your national language.
All Heartbeat affiliates agree to uphold the Commitment of Care and Competence. Click here to review the Commitment of Care and Competence.
If you are an organization applying for affiliation for the first time, please upload the documents you used to obtain your NGO.
Name and Address
First and last name will be shared with other visitors to the site.
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.
Checkout securely. Pay without sharing your financial information.
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Billing Name and Address
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