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2008 Membership Application

Membership dues paid  to the American Ambulance Association  are not tax deductible as charitable contributions; however, they may be tax deductible as ordinary and necessary business expenses. The IRS has determined that dues are non-deductible as a business expenses to the extent that they support lobbying activities.  The AAA budget projects 40% of dues revenue to be spent on lobbying and is therefore non-deductible.

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:

  1. 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.
  2. 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.

Class of Membership
Please select one

1. Active Member (voting) Any organization engaged in the business of providing fee for service ground ambulance transportation which meets the standards of the Board of Directors including governmental organizations, and is not eligible for any other membership category. Each active member organization shall designate a single representative who shall retain the sole authority and privilege of the member for the purposes of voting on official business of the Association. Only active Members can vote.Single-state Provider – The ambulance service pays a flat dues rate per ambulance up to a cap. The ambulance service receives one (1) vote for every twenty (20) declared ambulances up to five (5) votes total. The ambulance service may register one ambulance operation as an active member for each vote received. Annual Dues Per Ambulance: $208
Annual Dues Cap: $8,355
Votes:
one (1) vote 1-20 ambulances
two (2) votes 21-40 ambulances
three (3) votes 41-60 ambulances
four (4) votes 61-80 ambulances
five (5) votes 81+ ambulances
An ambulance operation located near a state border that performs ambulance transports in two states may not be required to pay multi-state dues. The requirement to pay multi-state dues applies when both of the following criteria are met:
  • the ambulance service maintains an “ambulance operation,” as defined above, in two or more states; and,
  • the ambulance service operates more than one hundred (100) ambulances
Multi-state Provider – For the first state in which it maintains an ambulance operation, the ambulance service pays the base dues rate (which is equal to the dues cap) and receives five (5) active memberships and five (5) votes. In addition, the ambulance service pays a flat dues rate for each additional state in which it maintains an ambulance operation. The ambulance service receives one (1) active membership and one (1) vote for each state. The ambulance service registers one ambulance operation for each active membership.
Annual Base Dues Rate: $8,355 (for initial state)
Annual Dues Per State: $1,500 (for each additional state)
Votes: five (5) votes plus one (1) vote per state
2. Associate Member (non-voting) Any entity engaged in the business of providing ambulance or public safety services which are government-operated fire departments, aeromedical services or ambulance services which are staffed predominately by unpaid volunteers:
Government Provider – Annual dues are a flat rate of $769.
Volunteer Provider – Annual dues are:
$208 -- less than ten (10) ambulances
$416 -- more than ten (10) ambulances
Aeromedical Provider – Annual dues are a flat rate of $769.
3. Affiliate Member (non-voting) Any person, partnership, corporation or other entity engaged in the manufacture, sale, rental or servicing of equipment or furnishing of services utilized in the provision of medical transportation. (Dues $1158.00 Annually)
5. State Association Member (non-voting) Any entity engaged in the business of providing member benifits to ambulance service providers for a specific geographic region in the United States. State Association Members must meet the standards prescribed by the Board of Directors. (Dues $274 Annually)
New members need to supply state verification of licensure when possible.

Standards of Conduct

In 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:
  1. Willful 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.
  2. Falsification of any information submitted to the Association.
  3. Failure to meet any financial obligation justly due the Association.
  4. Willful acts to discredit the Association.
  5. Representing the Association or expressing an opinion in the name of the Association without official authority.
  6. Theft or misappropriation of any property or any act to defraud the Association.
  7. Engaging in any activity which may conflict with the interests, goals, and objectives of the Association.
  8. Employee recruitment at any Association sponsored function.
  9. Any inappropriate use of Association materials, resources and information.
  10. No member shall knowingly engage in any illegal self-referral patterns. Illegal is meant to be any violation federal anti-kickback statutes.

I 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.

 Title
First Name
Middle Initial
Last Name
Position Title

Member Data

Company Name
Mailing Address
Address (cont.)
City
State Zip
Telephone
Fax
E-mail Address
Name of employee responsible for billing/reimbursement
Method Preferred
to receive Association info

FAX e-mail
If you select e-mail, up to 10 other company individuals can receive same info via e-mail at no additional cost. Please enter additional e-mail addresses below.
Additional e-mail address 1
Additional e-mail address 2
Additional e-mail address 3
Additional e-mail address 4
Additional e-mail address 5
Additional e-mail address 6
Additional e-mail address 7
Additional e-mail address 8
Additional e-mail address 9
Additional e-mail address 10
Years You Have Been in Business

 

Method of Payment Please select one
Payment must be made before membership will be approved. If paying by check please print a copy of this form before submitting it and mail it with payment to:
American Ambulance Association
8201 Greensboro Drive, Suite 300
McLean, VA 22102

Payment Method
Card/Account Number
Name on Card/Account
Expiration Date
Payment Amount
Dues are not deductible for charitable purposes, but may be deductible as a business expense. Please check with your tax adivsor.

Demographic Data

This information will remain anonymous and confidential and the data will be aggregated for statistical purposes only. Individual member data are not released under any circumstances. It is very important that you complete the following section!

Active Members
Ownership Classification for Active Members
Please select one item in each category
Business
Sole Proprietorship Partnership
Privately-Held Corporation Publicly-Held Corporation
Non-Profit Corporation
Government
City/County   Community
  Fire Department   Police Department
Other
  Volunteer   Hospital-Owned
  EMS Authority   Other

Do you charge a fee for services provided?
Yes No

Services Provided
Please check all that apply
Primary Emergency Provider Backup Emergency Provider
Inter-facility Transports First Responder Services
Stretcher Transports Wheel Chair Transports

Level of Services Provided
Please check all that apply

Basic Life Support Advanced Life Support
All-ALS Critical Care (RN-staffed)
Air Ambulance Other
Population Served
Please select one
Under 10,000 10,000-49,000
50,000-99,000 100,000-499,000
500,000-1,000,000 1,000,000+

Service Areas/Divisions
 Please breakdown percentages for emergency and non-emergency

Number of Cities % Emergency % Non-Emergency
Number of Counties % Emergency % Non-Emergency

Size of Operations:

Total Number of Licensed Ambulances in Fleet
Annual Number of Emergency Ambulance Responses
Annual Number of Emergency Ambulance Transports
Annual Number of Non-Emergency Ambulance Responses
Annual Number of Non-Emergency Ambulance Transports
Total Number of Employees
Number of Full-Time Employees
Number of Part-Time Employees
Number of EMTs
Number of Paramedics

Regulation of Emergency Operations
If you are a primary or back-up emergency provider, who regulates your services?

State Government Agency Local Government Agency
Local Medical Director/Society Other
Do you have External Medical Oversight? Yes No

Affiliate Members
Please describe your services below

You may join right now by submitting this application electronically with credit card information for payment, or you can print it and mail it with a check to:

American Ambulance Association
8201 Greensboro Drive, Suite 300
McLean, VA 22102

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American Ambulance Association · 8201 Greensboro Drive, Suite 300 · McLean, VA 22102 · 703-610-9018 · 1-800-523-4447 · 703-610-9005 fax
© 2007 American Ambulance Association. PRIVACY POLICY