|Click here for a PDF Membership Form|
Each entity seeking to become a member of the AAA must submit accurate information on the membership application. Each ambulance service wishing to be an Active Member of the AAA is required to declare certain information on the initial membership application and on the annual membership renewal notice:
- Each single-state ambulance service is required to declare (on the initial membership application and annual membership renewal notices) all of the ambulance vehicles that are licensed to transport patients.
- Each multi-state ambulance service is required to declare (on the initial membership application and annual membership renewal notices) each state in which they maintain an ambulance operation.
order to be considered for membership or retain membership
in good standing, no person or organization can be found
to have violated any of the provisions listed below:
violation, resulting in a conviction, of any federal,
state or local laws, including- fraud, larceny, bribery
or other egregious felonies, that would have an adverse
effect on the ambulance industry.
Falsification of any information submitted to the Association.
- Failure to meet any financial obligation justly due the
- Willful acts to discredit the Association.
- Representing the Association or expressing an opinion
in the name of the Association without official authority.
- Theft or misappropriation of any property or any act to
defraud the Association.
- Engaging in any activity which may conflict with the interests,
goals, and objectives of the Association.
- Employee recruitment at any Association sponsored function.
- Any inappropriate use of Association materials, resources
No member shall knowingly engage in any illegal self-referral
patterns. Illegal is meant to be any violation federal
understand that this application is subject to the approval
of the Board of Directors of the Association after it
has been reviewed and that, if this application is not
accepted all fees paid will be refunded in full. Until
such time, I shall be designated as a member applicant.
If elected to membership, I pledge to conform to the articles,
by-laws, code of ethics, professional standards and other
official acts of the American Ambulance Association.
|Select Membership Type|
|Population Served - Select One|
|Annual Number of Service Requests|
|Annual Number of Transports|
|Annual Number of Medicare Billed Transports|
|Top 5 cities/towns that make up the largest % of your transports:|
|Percentage of Transports Classified as Urban|
|Percentage of Transports Classified as Rural|
|Perecntage of Transports Classified as Super Rural|
|Percentage of Transports Classified as Emergency|
|Percentage of Transports Classified as Non-emergency|
|Percentage of Transports Classified as Medicare|
|Percentage of Transports Classified as Medicaid|
|Percentage of Transports Classified as Private Pay|
|Percentage of Transports Classified as Self Pay|
|Percentage of Transports Classified as No Pay|
|Percentage of Transports Classified as Other|
|Number of Registered Ambulances|
|Number of States Served|
|Total Number of Employees|
|Number of Full Time Employees|
|Number of Part Time Employees|
|Number of Volunteers|
|Who is the Congressman for your main location?|
|What other members of congress represent the geographical areas you serve?|
|If you are a primary or back-up emergency provider, who regulates your services?|
|Ownership Classification - Check All that Apply||Business Sole Proprietorship Partnership Privately-held Corporation Publicly-held Corporation Non-profit Corporation Government City/County/Community|
|Ownership Classification Continued||Community Fire Department Volunteer Police Department Hospital Owned EMS Authority Other|
|Services Provided - Check All that Apply||Primary Emergency Provider Backup Emergency Provider Inter-facility Transports First Responder Services Stretcher Transports Wheel-chair Transports|
|Affiliate Members - Check All that Apply||Ambulance Accessories/Equipment Ambulance Refurbish/Conversion Ambulance Sales/Manufacturing Communications Hardware/Software|
|Affiliate Members Continued||Consulting/Management Education/Training Financial Administration Insurance Legal Services Patient Handling/Supplies|
|Additional Representative Name and Email Address #1 (optional)|
|Additional Representative Name and Email Address #2 (optional)|
|Additional Representative Name and Email Address #3 (optional)|
|Additional Representative Name and Email Address #4 (optional)|
|Additional Representative Name and Email Address #5 (optional)|
|Method of Payment|