AFON Form - NRRTS

AFON application2021

Association Friend of NRRTS Application (AFON)

NATIONAL REGISTRY OF REHABILITATION TECHNOLOGY SUPPLIERS

Any charity or non-profit involved in the rehabilitation industry or profession not otherwise eligible to be a NRRTS registrant but meets the criteria for Association Friend of NRRTS (AFON) as established by the Corporation may be eligible to be affiliated as an AFON. AFONs are state, professional or national associations. An AFON must be sponsored by a NRRTS Registrant in good standing and approved by the Board of Directors of NRRTS as meeting all criteria as established by the corporation. There is no annual fee.
Five (5) complimentary FON affiliations (IFONs have access to NRRTS Education at 50% off and can participate on the NRRTS Listserve and a subscription to DIRECTIONS Magazine)
AFON corporate logo with hot link to corporate AFON web site on www.nrrts.org
Right of First Refusal on Event Sponsorships
AFON corporate logo on the back cover of DIRECTIONS Magazine.
NRRTS Registrant Name (Sponsor)*
First Last
Company Name*
Cell Phone*
Email*
I recommend the company noted above is an asset to our industry and will be an honorable CFON.
Signature of NRRTS Registrant -NRRTS will obtain on your behalf if you don't have one.
(Proposed) Association Friend of NRRTS information
AFON Primary Contact (name of individual)*
First Last
Company Name*
Corporate Phone Number*
Company Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Contact Name*
First Last
Primary Contact Cell Phone*
Primary Contact Email*
Company Phone*
Rehab Products and Services Supplied: (Check all that apply)*
If you chose "Other" please describe:
Complimentary Association Friends of NRRTS affiliations
Please provide name and contact information for the (5) complimentary Association Friends of NRRTS affiliations.
1. Complimentary AFON*
First Last
Email*
2. Complimentary AFON
First Last
Email
3. Complimentary AFON
First Last
Email
4. Complimentary AFON
First Last
Email
5. Complimentary AFON
First Last
Email
Association Friend of NRRTS (AFON) applicant Signature*
Proposal will not be processed without signature of proposer, AFON primary contact and Date.
Date Signed
MM slash DD slash YYYY
An annual renewal will be sent in January of each year to request updated published information about the organization and an update on its contribution to the rehab industry. Send completed form, payment of $1500USD (NRRTS can invoice), high-resolution logo in JPEG (minimum of 300 dpi) to Amy Odom

Association Friend of NRRTS Application (AFON)

(Proposed) Association Friend of NRRTS information

Complimentary Association Friends of NRRTS affiliations