Application for Assistance
If you have lost a child and are in need of help, please fill out our Application for Assistance. You can fill out the online form below or download the PDF, fill it out, and mail it to the address listed. In addition, please send us a copy of the Certificate of Death (you can also scan and email the certificate to info@theaubribrownclub.org). Once we receive your application and certificate, we will be in touch with you promptly.

Mail To:
The Aubri Brown Club
1868 Anne Marie CT
San Jose, CA 95132


Name:
Email:
Direct Phone:
Address:
Child Name:
Child Age:
Please share your story:
What kind of assistance do you need? Financial Assistance
Grief Counseling
To talk to others who have had similar experiences
Another kind of assistance (please include in the box below)
What else would you like to tell us?