Pediatric Perfusion Roster

The Pediatric Perfusion Chapter of AmSECT encourages pediatric perfusionists to complete the following form. The information that you enter will be added to the Pediatric Perfusion Roster. The roster is a database of contact information designed to facilitate networking among pediatric perfusionists worldwide. You can search the roster with Pediatric PerfSearch®. Please enter your information only once to prevent duplicate entries. If your profile changes, e.g., e-mail address change, please e-mail the changes to the AmSECT Webmaster at webmaster@amsect.org and he will make the requested changes to your profile.

First Name Last Name Licenses

E-mail

Workplace

City State/Province Country

Language Proficiencies (e.g., English, Spanish, etc.)

Is your center available for observation of pediatric perfusion procedures? Yes No

Are you available as a speaker? Yes No

If yes, what subject areas?

Special Pediatric Perfusion Interests