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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 50% 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.
Dues Per Ambulance: $218
Annual Dues Cap: $8,774

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: $8,774(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 $807.
Volunteer Provider – Annual dues are:
$218 -- less than ten (10) ambulances
$436 -- 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 $1216.00 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 $287.00 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
E-mail Address

Member Data

Company Name
Number of Ambulances in Fleet
Mailing Address
Address (cont.)
City
State Zip
Telephone
Fax
Years in Business
Name of employee responsible for billing/reimbursement
Web Site Address
List representatives
to receive AAA communications
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

Method of Payment
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
8400 Westpark Drive, Second Floor
McLean, VA 22102

Payment Method
Card/Account Number
Name on Card/Account
Expiration Date
Payment Amount
The IRS has determined that dues are non-deductible as a business expense to the extent that they support lobbying activities. The AAA budget projects 50% of dues revenue to be spent on lobbying and are therefore non-deductible.

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!

Ownership Classification:
Please check all that apply

Sole Proprietorship Partnership
Privately-Held Corporation Publicly-Held Corporation
Non-Profit Corporation Government
City/County/Community Community
Fire Department Police Department
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

Population Served
Please select one

Under 10,000 11,000-49,000
50,000-99,000 100,000-499,000
500,000-1,000,000 1,000,000+

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

Please check the option that best describes the impact of the Medicare ambulance fee schedule on your organization:

Positive Negative Neutral

Enter the percent of total transports according to current Medicare payment classifications

Urban
Rural
Super Rural

Size of Operations:

Square Miles in Service Area
Annual Number of Service Requests
Annual Number of Transports
Annual Number of Transports Billed to Medicare
Total Number of Employees
Number of Full-Time Employees
Number of Part-Time Employees
Number of EMTs
Number of Paramedics
Number of Volunteers (if applicable)

Affiliate Members - Please select all that apply

Accessories/Equipment Consulting/Management
Ambulance Refurbish/Conversion Education/Training
Ambulance Sales/Manufacturing Financial/Administration
Insurance Legal Services
Patient Handling and Supplies Communications- Software

All applications will be reviewed and approved by AAA staff and Board of Directors. All memberships are considered provisional until final approval at the next Board of Directors meeting.

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
8400 Westpark Drive, Second Floor
McLean, VA 22102

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American Ambulance Association · 8400 Westpark Drive · Second Floor · McLean, VA 22102 · 703-610-9018 · 1-800-523-4447 · 703-610-0210 fax
© 2007 American Ambulance Association. PRIVACY POLICY