air ambulance
air ambulance medivac
medivac
air ambulance

Become a Provider

Please enter the following information to become a provider for AirAmbulanceBroker.com.  We will review your application and you will be notified by email when your account has been activated.  Until your account is activated you will not begin receiving requests for quotes.
Fields marked with * are required.

If you already have a provider account, please login first:
Personal Information
Contact Name: *  *
Address: *
Address Line 2:
City: *
State/Province/County: *
Postal/Zip Code:
Country: *
Phone:
(country code & number)		 +  
Fax:
(country code & number)		 +  
Preferred Currency:

Company Information
Company Name: *
Address: *
Address (Line 2):
City: *
State/Province/County: *
Postal/Zip Code:
Country: *
Telephone:
(country code & number)		 +  
Fax:
(country code & number)		 +  
Website:
24/7 Evac. Telephone:
(country code & number)		 +  *
24/7 Evac. Fax:
(country code & number)		 +  *
24/7 Evac. E-mail: *
How many years have you
been operating air ambulances?
Do you also provide
medical escort services?:		 Yes:   No:
Would you like to receive reminders to post empty legs? (Uncheck to opt out) Yes:

Professional Associations and Accreditations
What professional aviation
associations do you belong to?
(Check all that apply) 		 National Business Aviation Association (NBAA)
 European Business Aviation Association (EBAA)
 Middle East Business Aviation Association (MEBAA)
 Asian Business Aviation Association (AsBAA)
 Latin American Business Aviation Association (LABAA)
 FlightSafety Foundation
 British Business And General Aviation Association (BBGA)
 International Air Transport Association (IATA)
 International Civil Aviation Association (ICAO)
 
What professional medical
associations do you belong to?
(Check all that apply) 		 European Aero-Medical Institute (EURAMI)
 Air Medical Physician Association (AMPA)
 Association of Aeromedical Services (AAMS)
 Society of Critical Care Medicine (SCCM)
 Commission on Accreditation of Medical Transport System (CAMTS)
 Clinical Considerations in Aeromedical Transport (CCAT)
 Royal College of Nursing, In-Flight Nurses Association
 Air & Surface Transport Nurses Association
 International Association of Flight Paramedics
 
What professional accreditations
do you have?
(Check all that apply) 		 Commission on Accreditation of Medical Transport System (CAMTS)
 European Aero-Medical Institute Accreditation (EURAMI)

Define Service Routes

I am a world wide provider of air ambulance services.
(Select to receive all requests regardless of location.)
Please select two regions between which you will pick up and drop off patients.
(You will only receive requests for quotes that travel along your defined service routes.)
Africa - East
Africa - Middle
Africa - Southern
Asia - Eastern
Asia - South-Central
Asia - South-Eastern
Caribbean
Central America
Europe - Eastern
Europe - Northern
Europe - Southern
Europe - Western
Melanesia
Micronesia
Middle East
North America - Non-US
Oceania
Polynesia
South America
United States - Midwest
United States - Northeast
United States - Southern
United States - Western

Please note that all routes are bi-directional.

  

Please type or paste your standard terms and conditions in this box.

Login Information
Contact E-mail Address: *
Choose a Password: *  Minimum 5 characters
Confirm Password: *
Warning:

This site is ONLY for use by Air Ambulance Providers who have the appropriate certificate, registration and/or licensing to operate as such. Brokers, third party aircraft operators or other persons representing themselves as an Air Ambulance Provider may not register and will be denied access upon submission of registration.

You acknowledge and agree that Your use of this site other than for the purposes of providing Quotes for air ambulance services to Seekers will have a negative impact on this Website and AirAmbulanceBroker.com, which could result in Your being liable to pay AirAmbulanceBroker.com for that harm. Please read more in the AIRAMBULANCEBROKER.COM PROVIDER ACCESS AGREEMENT to make sure you understand Your obligations before you begin using this site. PLEASE REPORT ANY USES OF THIS WEBSITE FOR OTHER THAN THE ABOVE PURPOSES TO


*  I have read and agree to the AirAmbulanceBroker.com Terms of Service


evacuation services
medical assistance
medical assistance