The Introductory membership is provided for the newly bereaved or for first time members who have just now found Alive Alone at no cost. A welcome packet will be sent once vetted so please complete the registration form. During this introductory period two newsletters will be sent. Please contact memberships@alivealone.org with any questions. This free introductory membership does not include access to members only areas of the web site.

Membership in Alive Alone is for parents with no surviving children. In other words, for a parent who has suffered the death of an only child, or of all their children. Please complete the registration form, and email memberships@alivealone.org if there are any questions.

Name:*

First Name Required Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

-- Select Country -- United States (US) Afghanistan Åland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belau Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba CuraÇao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Republic of Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Martin (Dutch part) Saint Pierre and Miquelon Saint Vincent and the Grenadines San Marino São Tomé and Príncipe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia/Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom (UK) Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Western Samoa Yemen Zambia Zimbabwe

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Email:* Email is Required

Phone Number:* Phone Number is Required

Marital Status: Marital Status is not valid

Single / DivorcedMarriedOtherPrefer Not to Say

Spouse /Significant Other / Other Parent's First Name: Spouse /Significant Other / Other Parent's First Name is not valid

Spouse /Significant Other / Other Parent's Last Name: Spouse /Significant Other / Other Parent's Last Name is not valid

Child's First Name:* Child's First Name is Required

Child's Middle Name: Child's Middle Name is not valid

Child's Last Name:* Child's Last Name is Required

Child's Gender:* Child's Gender is Required

MaleFemaleSkip

Child's Birth Date:* Child's Birth Date is Required

Child's Date of Death:* Child's Date of Death is Required

Child's Cause of Death:* Child's Cause of Death is Required

Child's First Name (2nd Child): Child's First Name (2nd Child) is not valid

Child's Middle Name (2nd Child): Child's Middle Name (2nd Child) is not valid

Child's Last Name (2nd Child): Child's Last Name (2nd Child) is not valid

Child's Gender (2nd Child): Child's Gender (2nd Child) is not valid

Birth Date, 2nd Child: Birth Date, 2nd Child is not valid

Date of Death, 2nd Child: Date of Death, 2nd Child is not valid

Cause of Death, Second Child: Cause of Death, Second Child is not valid

Child's First Name (3rd Child): Child's First Name (3rd Child) is not valid

Child's Middle Name (3rd Child): Child's Middle Name (3rd Child) is not valid

Child's Last Name (3rd Child): Child's Last Name (3rd Child) is not valid

Child's Gender (3rd Child): Child's Gender (3rd Child) is not valid

Birth Date, 3rd Child: Birth Date, 3rd Child is not valid

Date of Death, 3rd Child: Date of Death, 3rd Child is not valid

Cause of Death, 3rd Child: Cause of Death, 3rd Child is not valid

Do You Have Any Other Deceased Children? If so, please include their names, birth and death dates, and cause of death in this text field.: Do You Have Any Other Deceased Children? If so, please include their names, birth and death dates, and cause of death in this text field. is not valid

Are you interested in our One-to-One Members Connection Listing? (requires release) This is a list of member's first name, email address, approximate location, child's age at death, and cause of death. Must opt in to be listed.:* Are you interested in our One-to-One Members Connection Listing? (requires release) This is a list of member's first name, email address, approximate location, child's age at death, and cause of death. Must opt in to be listed. is Required

Yes No

Please let us know how you found out about Alive Alone:: Please let us know how you found out about Alive Alone: is not valid

Family / Friend Online Search Attended a Conference for Bereaved Parents Alive Alone's Facebook Page Other Social Media Other

Other Comments or Question: Other Comments or Question is not valid

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Password Strength  Password must be "Medium" or stronger

I have read and agree to the Terms Of Service (Terms of Service open in a new tab when you click here)*

This site collects names, emails and other user information. I consent to the terms set forth in the Privacy Policy.

 

No val Please fix the errors above

Pay Alive Alone

Free

	Introductory Membership (free for six months) – Payment Free	$0.00
	Total	$0.00