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Member type

Ambulance Provider

Affiliate

Groups or organizations whose activities support ambulance service (e.g., vendors, consultants, professional organizations, and fire/medical departments without a CON).

NOTE: Due to the percentage of AzAA expenses spent on lobbying efforts, 85% - 95% of dues may not be tax deductible by the member. Please contact your tax professional for further guidance.

Attention Ambulance Providers
Membership dues are based on the number of transports your organization reported in its most recent ARCR. Please have this number available before beginning the registration process.
At the conclusion of registration, you will be able to select a payment method—credit card or invoice. Be sure to have your preferred option and any necessary payment details ready in advance.

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Please fill out the following information in order to become a member.

Organization Information

Name: *

Address: *

Website:

Medical director:

Billing Information

Agency billing company: *

Billing Company Address: *

Agency Phone Number:

Agency EPCR company:

Personal Information

First Name: *

Last Name: *

Name Suffix:

Gender:

Title: *

Address: *

Area Code:

Mobile Phone Number:

User account

Email: *

Password: *

Confirm Password: *

NOTE: All information entered below will be visible to site administrators. If your email address is made "Private" it will not be displayed in the profile, however, members can still contact you via email through the site's group email system if permitted by the group administrator.