Ambulance Membership Program AgreementAmbulance Membership Program Agreement • July 9th, 2019
This agreement provides membership in the ambulance subscription service known as the AFMA Ambulance Membership Program. The annual membership fee per household (‘household’ defined as legal spouse or domestic partner including children under the age of 26, living at the address) provides emergency ground ambulance service and medically necessary non-emergency ground ambulance service authorized by a physician within the approved AFMA service area, to the nearest appropriate medical facility, for the subscriber and household members for one year, effective the date your completed subscription agreement and fee are received and approved by the Authority. Membership also provides physician-authorized, medically necessary ambulance service from a point within the AFMA approved area to any other hospital within the State of Arizona. The annual fee for this service is currently $75.00 per household.
Ambulance Membership Program AgreementAmbulance Membership Program Agreement • February 20th, 2024
This Ambulance Membership Program Agreement ("Agreement") is entered into by the member identified below, and the member's spouse/dependent(s) listed on the Enrollment Form (collectively, the 'Member"), and the Adams County Fire Protection District ("District").
Ambulance Membership Program AgreementAmbulance Membership Program Agreement • March 29th, 2017
This Ambulance Membership Program Agreement ("Agreement") is entered into by the member identified below, and the member's spouse/dependent(s) listed on the Enrollment Form (collectively, the 'Member"), and the Adams County Fire Protection District ("District").
