Membership Application
SCAA Membership Application Active Member – (voting) Any organization engaged in the business of providing fee for service ground ambulance transportation, licensed by the California Highway Patrol, and the Los Angeles County Emergency Medical Services Agency or the Orange County EMS Agency. Member Companies may have up to three designated representatives participate in SCAA meetings, but each Member Company has one vote on matters of official business as voted on by the Association. Only active members can vote.
Commercial Member – (non-voting) A Commercial Member is any person, partnership or duly existing and qualified corporation, manufacturing, renting, selling equipment or providing service used by private professional ambulance providers. Commercial Members shall not be entitled to hold office or vote.
Select Appropriate Membership Class Company Entity Information
Are Changes Required to your Company Information On File with SCAA?
Mailing Address Preference Is your business address your preferred mailing address?
General Manager Phone Type
Operations Manager Phone Type
Company License Information
Does your company hold a valid CHP 360A Emergency Ambulance License
STOP. All SCAA Active Members must hold a valid CHP 360A Emergency Ambulance License. Please do not complete and submit this application without such license.
Los Angeles County License Information
Does your company hold a valid Los Angeles County TTC Ambulance Operator’s Business License and approved as a Ground BLS Ambulance Service in good standing by the Los Angeles County EMS Agency?
City of Los Angeles License Information
Is your company permitted by LA-DOT to operate one or more ground ambulances within the City of Los Angeles?
Orange County License Information
Is your company permitted by OCEMS to operate one or more private ground ambulances within the County of Orange?
SCAA Designated Company Representatives
SCAA Primary Representative (Other) Phone Type
SCAA Alternate Rep. 1 (Other) Phone Type
SCAA Alternate Rep. 2 (Other) Phone Type
In order to be considered for membership or retain membership in good standing, no person or organization can be found to have violated any one or more of the following standards:
1. Conviction of any Federal, State, local laws, including fraud, larceny, bribery, or other egregious felonies that would have deleterious effects on the ambulance industry.
Member Entitlements and Responsibilities Acknowledgement
I understand that only Active Members representing private for profit ambulance services are entitled to hold office and vote and that this application is subject to the approval of the Board of Directors of the Association, and that if this application is not accepted, my application fee will be returned in full. Until such time, I shall be designated as a member applicant. If elected to membership, I pledge to conform to the articles, bylaws, standards of conduct, code of ethics, professional standards and other official acts of the Southern California Ambulance Association.
Please check the Membership Acknowledgement box below. Membership Acknowledgement
Data Retention and Use Consent
Please check the Data Retention and Use Consent box below. Data Retention and Use Consent *
SCAA Membership Dues Information
SCAA Membership Dues:
The renewal amounts indicated below each include an internet convenience fee.
SCAA Membership Dues Payment Options
Payment Summary and Method
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Please ensure all required fields on this form are completed, check the Submitter Certification box below, and affix your signature in Signature Field below before pressing the Submit Button to submit this Membership Application and Dues Payment. Submit Membership Application and Dues Payment
