Whether you are an abortion provider; an individual clinician; a student, resident, or fellow; or an advocate, there's a place for you in our community. Membership Online Application Membership Online Application Application DetailsReferencesAgreement Payment Are you interested in joining NAF as a(n): * Facility or organization that provides abortion care (private and non-profit clinics, Planned Parenthood affiliates, women’s health centers, physicians’ offices, hospitals, and telehealth providers) Individual that supports abortion access Pro-Reproductive Freedom Organization Which category best describes you: * Clinicians in Abortion Care (CIAC): For Advanced Practice Clinicians (CNM, CPM, LM, PA, NP), RNs, LVNs/LPNs, enrolled students, and retired clinicians Clinician Provider at a Non-Member Institution Clinician Provider at a Member Institution Allied Health Professionals (individuals who work in other health care fields, including social workers) Canadian Medical Abortion Providing Clinician (individuals who do not provide more than 100 medication abortions per calendar year) Student Resident or Fellow NAF Associate (non-clinicians who are working in the field of reproductive health, reproductive rights, or reproductive justice) Retiree Member If you have questions about which category of membership you should choose, please contact NAF’s Membership Department at [email protected]. Which category best describes your organization: * Pro-Choice Cooperating Organization Reproductive Health Care Organization International Organization Pro-choice Cooperating Organization members provide grassroots organizing, advocacy or coalition building, community or professional education, legal services, public outreach, clinic defense, research, and/or referrals in accordance with NAF’s mission. Reproductive Health Care Organization (RHCO) members provide family planning and/or reproductive health services—not including abortion—in proprietary clinics, nonprofit clinics, feminist clinics, physicians’ offices, and/or facilities affiliated with hospitals. International Organization members provide abortion care, reproductive health care, family planning, grassroots organizing, advocacy or coalition building, community or professional education, legal services, public outreach, clinic defense, research, and/or referrals in accordance with NAF’s mission. Organizations based wholly or in part in North, Central, or South America are not eligible for this category of membership; for information on other membership categories please contact the Membership Department at [email protected]. Facility Application Details Name of Institution: Institution Street Address: Institution Street Address: Street Address Street Address Address Line 2 Address Line 2 City City State / Province State / Province ZIP / Postal Code ZIP / Postal Code Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Institution Mailing Address: Institution Mailing Address: Street Address Street Address Address Line 2 Address Line 2 City City State / Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State / Province ZIP / Postal Code ZIP / Postal Code Mailing Privacy: Please only mail to me in a plain envelope Institution Contact Information: Administrative Telephone Number: Appointments Telephone Number: Toll Free Telephone Number: Fax Number: Emergency Contact Name: Emergency Contact Name: First Name First Name Last Name Last Name Emergency Contact Telephone Number: Facility Manager Name: Facility Manager Name: First Name First Name Last Name Last Name Facility Manager Email Address: Facility Manager Date of Birth: Medical Director Name: Medical Director Name: First Name First Name Last Name Last Name Medical Director Email Address: Medical Director Date of Birth: NAF Representative Name: NAF Representative Name: First Name First Name Last Name Last Name The person you have designated to serve as your official NAF representative will be the primary NAF contact and authorized to vote in NAF elections on behalf of your facility. Please note that any future change in designation must be made in writing to NAF. NAF Representative Title: NAF Representative Email Address: * NAF Representative Date of Birth: * Has your facility previously applied for NAF membership? Yes No Date of prior application: Is your facility known by any other name? Yes No Please provide other facility name: Would you like to be listed on the “Find a Provider” section of the NAF Website? Yes No Facility Name to be Listed: Facility Address to be Listed: Facility Address to be Listed: Street Address Street Address Address Line 2 Address Line 2 City City State / Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State / Province ZIP / Postal Code ZIP / Postal Code Facility Phone Number to be Listed: Facility Website to be Listed: Facility Governance: Profit Not-for-Profit Facility Ownership: Individual Owner Partnership Business Corporation Not-for-Profit OtherOther Facility Not-for-Profit Tax Status: Facility EIN: Please list all owners or partners of the facility or corporation and/or a list of members of the Board of Directors: List any physicians who may have oversight or who have written or may write policies and procedures for your facility: Is your facility currently licensed or accredited by any national, state, or local agency? Yes No ex: Joint Commission, AAAHC, CLIA, etc. Please attach any current licensure or accreditation: Drop a file here or click to upload Choose File Maximum file size: 52.43MB Agency Name: License #: Date of most recent review: Facility Services: Is your facility currently providing abortions? Yes No Start date (if any): How many total abortions (medication & in-clinic) were performed at your facility in the last calendar year? If your facility has not yet begun providing abortions, how many procedures do you project for the coming year? Do you provide any of the following non-abortion services? Well-woman and gynecological care Family Planning services Emergency Contraception STD testing and education HIV testing and education Post-abortion counseling Trans care LGBTQ Services Other Please specify for Other: Are you a hospital or in a hospital setting? Yes No Do you provide medication abortion? Yes No Maximum LMP limit (weeks): Do you provide Manual Vacuum Aspiration? Yes No Maximum LMP limit (weeks): Do you provide Machine Vacuum Aspiration? Yes No Minimum LMP limit (weeks): BPD limits for later patients if relevant: Do you offer 2nd Trimester Abortion? Yes No Maximum LMP limit (weeks): Method: D&E Induction Do you offer 3rd Trimester Abortion? Yes No Maximum LMP limit (weeks): Method: D&E Induction What days and hours does/will your facility provide abortions? Days Hours plus1 Add minus1 Remove Clinician Questionnaire: Please complete for any clinicians providing abortions for your facility. Clinician Name: Graduate School, Degree & Graduation Date: Specialty: Date of Birth: Federal DEA Number: State & License Number: Insurance Carrier: plus1 Add minus1 Remove Individual Application Details Name Name First Name First Name Last Name Last Name Pronouns: Employer (enter "Student" if student applicant): Name of Employer: Medical School: Institution where you obtained your clinical degree: * Name of College or University: Name of residency/fellowship program (if applicable): Graduation Date (or projected graduation date): * Degree Designation: Mailing Address: Mailing Address: Street Address Street Address Address Line 2 Address Line 2 City City State / Province State / Province ZIP / Postal Code ZIP / Postal Code Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Mailing Privacy: Please only mail to me in a plain envelope Telephone: Email Address: * If you work at a Planned Parenthood Affiliate, please use your Planned Parenthood email address. Date of Birth: * LinkedIn URL Employer/Affiliation Federal DEA Number (for U.S. applicants): State & License Number: CMPA Member (for Canadian applicants)? Yes No College of Physicians & Surgeons Province and License Number(s) NPI (National Provider Identifier) Insurance Carrier: Medical School Degree: Have you previously applied for NAF membership? Yes No Have any medical boards and/or state licensing or regulatory agencies in any jurisdiction in which you have operated filed any actions against you? Yes No Have any medical boards and/or provencial licensing or regulatory agencies in any jurisdiction in which you have operated filed any actions against you? Yes No Please attach documentation of present status of all such actions Drop a file here or click to upload Choose File Maximum file size: 52.43MB Alternatively, you can email documents to [email protected]. Please describe your involvement with abortion care, reproductive health care, family planning, grassroots organizing, advocacy or coalition building, community or professional education, legal services, public outreach, clinic defense, research, referrals and/or other activities as they relate to abortion, reproductive freedom, and health care: Pro-Reproductive Freedom Organization Application Details Organization Name: Is your organization known by any other name? Yes No Please provide other organization name: Organization Street Address: Organization Street Address: Street Address Street Address Address Line 2 Address Line 2 City City State / Province State / Province ZIP / Postal Code ZIP / Postal Code Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Organization Mailing Address: Organization Mailing Address: Street Address Street Address Address Line 2 Address Line 2 City City State / Province State / Province ZIP / Postal Code ZIP / Postal Code Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Mailing Privacy: Please only mail to me in a plain envelope Telephone Number: NAF Representative Name: NAF Representative Name: First Name First Name Last Name Last Name The person you have designated to serve as your official NAF representative will be the primary NAF contact and authorized to vote in NAF elections on behalf of your facility. Please note that any future change in designation must be made in writing to NAF. NAF Representative Title: NAF Representative Email Address: * NAF Representative Date of Birth: Please describe your organization’s goals and services as they relate to abortion, reproductive freedom, and health care: If you are human, leave this field blank. Next
