The Association for Pet Loss and Bereavement · PO Box 106 · Brooklyn, NY 11230 · (718) 382-0690 · aplb@aplb.org

Join the APLB or Renew Your Membership

(If want to submit a memorial for your pet, please use the Pet Memorial form.)

The basic annual membership in the APLB is $25; seniors (age 60 and up) are eligible for a $5 discount. Applicants who wish to add a permanent pet memorial may apply for the “Basic Membership and Memorial”.

Membership Types
Basic Membership	$25
Senior Basic Membership (Age 60 and up)	$20
Basic Membership and Memorial (includes membership for one year and permanent memorial)	$50
Senior Basic Membership and Memorial (Age 60 and up) (includes membership for one year and permanent memorial)	$40

The APLB is designated by the US Internal Revenue Service as a 501(c)(3) nonprofit, tax-exempt organization. All your expenditures here are fully tax-deductible.

This is a

New Membership Renewal

Membership Type
	Basic Membership	$25
	Senior Membership (Age 60 and up)	$20
	Basic Membership and Memorial (includes membership for one year and permanent memorial)	$50
	Senior Basic Membership and Memorial (Age 60 and up) (includes membership for one year and permanent memorial)	$40

Additional Donations
	Patron Angel	$75
	Silver Angel	$100
	Gold Angel	$200
	Platinum Angel	$300
	Other
	None

Contact Information Your privacy is very important to us, and this information will be submitted over a secure server connection. No data you provide while joining or donating on this website will be used for any other purpose than fulfilling your order. **Required fields
**First Name
**Last Name
Title
**Street Address

**City
State Province
District	(for addresses not in USA or Canada)
ZIP / Postal Code
Country
Telephone	North America: ()
	Outside North America: (Please include your country code)
**E-mail

Credit Card Information

** Credit Card	Visa American Express MasterCard Discover
** Card Number
**Expiration Date

About Yourself

How did you first hear about us?

Do you have any pets now? What are their names and breeds?

Are you presently going through a bereavement process for a beloved pet, or is one terminally ill at this time? How may we help you with this?

Do you have any special skills or talents you would like to volunteer for the APLB?

Would you like to be on any of our committees? Please check the box next to any committee in which you are interested.

Conferences
Fund Raising
Internet
Newsletter
Publicity

What additional benefits would you like to see the APLB provide for its members?

What is your occupation?

Do you have any degrees?

If you have any comments, questions, or suggestions, please enter them here.