International Directory of Spinecare Products

An Organization of Healthcare Professionals Dedicated to Excellence in Spinecare

Buying Advantage Program Application

Contact First Name:
Contact Last Name:
Company
Company Address
City:
State:
Country:
Zip Code:
Primary Phone:
Secondary Phone:
Mobile Phone:
Fax Number:
Product/Service:
Company Web Site http://

How Did You hear about The AASP:
Email:
Confirm Email:

Company Mission:
Company Overview:
Featured Products/Services:(Optional)
Special Offer to AASP Members:( Required )
Statement About The AASP: (Optional)
Statement About The ISA: (Optional)

Buying Advantage Program ( $600 per year )

Directory Listings

For the annual fee of $600 you are entitled to be listed on the following three online product/service directories. You have the option to limit your listing to one or more directories. Please mark the box of the directories you wish to be listed on

	AASP Buying Advantage Directory which provides exposure to healthcare professionals who are members of the American Academy of Spine Physicans.
	ISA Buying Advantage Directory which provides exposure to the public who are members of the International Spine Association.
	International Directory of Spinecare Products which provides exposure to healthcare professionals, companies and the public, worldwide, who may or may not be members of a spine organization.

Public / Non Public Products ?

If you wish to be placed on all three directories but your service and/or products are not directly sold to patients or the public please mark the appropriate box below and the corresponding statement will be placed on your directory

	Products and/or services are not provided directly to the public
	Products and/or services are only provided to licensed healthcare practitioners

Special Offer Status

Companies are required to provide a special offer to members of the AASP and are encouraged to provide a special offer to members of the ISA. Please denote the statement or statements you wish to have appear on the special offer area of your directory listing

	A special offer is available to the public who are members of the ISA
	A special offer is available for healthcare professionals who are members of the American Academy of Spine Physicians (AASP)

PLEASE NOTE:

Your AASP Buying Advantage Program membership will automatically renew one calendar year from the date of membership acceptance or renewal, unless the AASP is specifically notified in writing by the member 30 days or more prior to the renewal date. Please address all correspondence to the AASP Office of Member Services. Phone: (847) 697-4660


Card Number:
Name on Card:
Expiration Date:	/
Card Type:
Billing Address:
City:
State/Province:
Zip:
Country:

Participation in the AASP Buying Advantage Progam and listing on the AASP Buying Advantage Directory is a marketing opportunity and does not constitute an endorsement of your company or its products/services by the AASP. You are therefore prohibited from using the AASP name, trademarks, logos or other protected material for that purpose. You may acknowledge that you are a member (participant) in the AASP Buying Advantage Progam and that you provide members with a "special offer/opportunity".

	Name:		Phone:
	Agree		Disagree