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Thank you for your interest in 911Lifeline.

To expedite processing of your application, please make sure you complete all fields.
If your prefer, you can download a PDF application, and submit it by mail.

If you have any questions about membership, email membership@911lifeline.org.
For questions about 911Lifeline email info@911lifeline.org, or call us at (800) 520-2181.

Note: Public safety agency memberships are available. These offer multiple individual memberships at a discount. Please contact our membership department for the details. Email membership@911lifeline.org, or call (800) 520-2181, and press 1.

For field-specific information, click a help icon ().

Member Categories Select a  Member Name 
Active Member 
Annual Dues: $12.00
9-1-1 Professional
Associate Member 
Annual Dues: $50.00
Organization   Vendor
Member Name:  
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Password:
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Personal Information Agency/Organization/Company Information
First Name:
Last Name
Date of Birth:
YYYY-MM-DD)
Email:
Phone:
Address Line1:
Address Line2:
Country: U.S.  Canada 
City:
State/Provence:
ZIP/Postal Code:
Citizenship  U.S.  Permanent Resident  Canada
Terms and Signature
I certify that all of the information on this application is true. I understand that
any falsification, or misrepresentation is cause for denial of this application, or
to revoke my existing membership.  I also understand that an application for an
active membership is subject to verification of eligibility.
I have read and accept the these terms.
Sign your application by entering text that will
uniquely identify you. Your initials plus the last
four digits of your Social Security number is a
recommended signature (e.g. ABC1234).

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Agency Name:
Title:   Check if Retired
Email:
Phone:
Address Line1:
Address Line2:  
Country: U.S.  Canada 
City:
State/Provence:
ZIP/Postal Code:
Contact Preferences
For Email: Agency  Personal
For Mail: Agency  Personal
Yahoo Membership
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How did you hear about 911Lifeline?
Mailing Address:
Membership
911Lifeline, Inc.
2732 Flushing Road
Flint, MI 48504