User Name & Password Request Form

Effective November 1, 1996, the Members Only section of AmSECT's Perfusion Channels© became restricted to AmSECT members in good standing. If you are not currently a member, please join AmSECT now to have access to this part of Perfusion Channels.

If you already have a user name and password, but would like to change one or both of them, then please complete this form.

If you have forgotten your user name and password, then please e-mail Judy Luther and ask for your user name and password to be e-mailed to you. Note: Make sure that you are sending the e-mail message using the e-mail address that the National Office has on file for you. Otherwise, call the National Office at 703-435-8556, so that we can verify your membership information.

If you are currently an AmSECT member, but do not have a user name and password, then please submit your preferred choices for a user name and password to access the Members Only section of Perfusion Channels© below. The National Office will notify you by e-mail to verify that your choice for a user name and password has been approved. If you do no have e-mail, please indicate None in the space provided for e-mail. A postcard will be mailed to you verifying your choices for a user name and password.

Thank you

AmSECT Webmaster


Name:

E-mail Address:

Address:

Instructions:

User names must be between four and twenty characters in length. The user name is not case sensitive. Spaces may be used. However, the following characters cannot be used in the user name: " / \ [ ] : ; | = , + * ? < >

Passwords must be between four and fourteen characters in length. The password is case sensitive, e.g., PaSsWoRd

User Name (1st Choice):

User Name (2nd Choice):

User Name (3rd Choice):

Password:

Confirm Password: