AAF Individual Membership Form
With your membership, you will be helping the Foundation continue to reach out and provide amputees with much needed information and referral to other helping agencies.
Individual annual membership fee: $25
Name:
Email:
Address:
City:
State:
Zip:
Date of Birth:
Present Age:
Level of Amputation:
Cause of Amputation:
AAF Professional Membership Form
The Professional Memberships are for prosthetic facilities, individual prosthetists, prosthetic manufacturers, and other organizations.
Along with the basic Professional Membership, there is an opportunity to post an Internet link within your listing on our web site, annually charged in addition to the Professional membership dues.
To learn more about the membership benefits review
Facility Name:
Address:
City:
State:
Zip:
Phone Number:
Fax Number::
Email:
Web Address
Contact Name:
Please select one
Copyright © 2004 - 2023 American Amputee Foundation, Inc. All Rights Reserved.
P.O. Box 94227
North Little Rock, AR 72190
501-835-9290 / 501-835-9292 Fax
Email: [email protected]
