LHM Membership Form – Parent who has lost a child because of complex congenital heart disease

Your Details

Your Name(Required)
Address(Required)
Some people use a different name on social media. Providing this will help us speed up your acceptance into our private groups.
Child's date of birth(Required)
Date your child passed away(Required)
Please provide, in full, the names, date of birth and gender of all siblings. Alternatively, state 'none'.

Contact Preferences

Would you like to be put in touch with someone who has shared similar experiences?(Required)
If you would like to receive updates about the work of LHM, including support & information, fundraising and awareness campaigns, please indicate below your methods of contact:(Required)
Membership Terms(Required)