CONFIDENTIALITY NOTICE

All information submitted in support of enrollment on the EmergntHelp.org secured website by or on behalf of an individual shall be retained as confidential information and not disclosed to anyone without the express written permission of the person enrolling, or as may be required to be disclosed by law.

QUALIFICATIONS

The applicant must complete the Enrollment Agreement, certify, and provide proof of the following:

  • He, or she, is 18 years of age or older and a resident of the state, or territory, within the United States where domiciled.
  • If enrollment is being made on behalf of a minor child, incapacitated person, or other family member, proof of that relationship and authority to act on behalf of that person must be submitted at time of enrollment.

PHOTO IDENTIFICATION OPTION

Application for enrollment on EmergentHelp.org may be accompanied by a current photograph of the applicant, minor child, family member, or group family photo.  If submitted, the photo should be taken in a high resolution JPEG or IMAP picture format, on a white or light blue background, suitable for inclusion on the website, or on an identification card, not more than 1MG in size.  All applicants shall be responsible for all costs related thereto.

ENROLLMENT FEE

    $29.99 per person – Includes one (1) year enrollment on a EmergentHelp.org private web page with photo image, permitted contact and special alert information; printable online EmergentHelp-ID card image sheet; Digital Polyester EmergentHelp-ID card with photo and QR Code square image; EmergentHelp SCAN TO HELP ME wristband

    ENROLL NOW….ENROLL NOW

    To Enroll Online, access and complete Online Enrollment Application below, and pay online. You will then receive an email confirmation with your assigned Personal Identification Number (PIN), confirming your entered username and password. Re-access your account through the Online Enrollment Login link, and print PDF EmergentHelp ID card images. You will then receive your Polyester ID card and wristband in the mail.

    Online Enrollment Application
    Online Enrollment Login

    or

    To Enroll Offline, see below, print, complete, and submit application form in pdf format, and required photo, in either JPEG or IMAG picture format, by email to  assist@EmergentHelp.org, or by mail to PPS Collateral Services, LLC, 56 Park Place, Newark, NJ 07102.   Enrollment fees must accompany the application.

    Enrollment Terms & Condition Application Form

    Sample ID Card