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. New and continuing members will also receive the Active Living Magazine, published four times a year.

Individual annual membership fee: $25

Name
Email
Address
City
State
ZIP
Date of birth:
Present age:
Level of Amputation:
Cause of Amputation	Disease Trauma Congenital

Donations are also welcomed and appreciated! The American Amputee Foundation, Inc. is a non-profit educational entity organized under Section 501 (c)(3) of the IRS code. Membership fees are deductible by members as an ordinary and necessary business expense. Contributions or gifts to AAF are deductible as charitable contributions for federal income tax purposes. Federal ID number: 51-0162022

Phone: (501) 835-9290
Email: info@americanamputee.org