Petition for retired perfusionist status

What you need   for Petition for retired perfusionist status

You are eligible to submit a petition for retired status, if you:

• Meet the eligibility requirements in 267 CMR 3.11(2)
• Have a license that is not surrendered, suspended, or revoked at the time of the petition
• Demonstrate, to the board's satisfaction, that you intend to permanently retire from active practice in the Commonwealth and in all other jurisdictions

You will also need your:

• License number
• Address
• Telephone number
• Email address
• Date of birth

How to submit   Petition for retired perfusionist status

By mail +

1. Download and complete the form, found below
2. Mail completed form to:
   
   Board of Registration of Perfusionists
   239 Causeway St.
   5^th Floor, Suite 500
   Boston, MA 02114

By fax +

1. Download and complete the form, found below
2. Fax completed form to (617) 973-0980

Downloads   for Petition for retired perfusionist status

Open DOC file, 38.5 KB,  Retirement Application (English, DOC 38.5 KB)

Contact   for Petition for retired perfusionist status

Board of Registration of Perfusionists

+

Address

250 Washington Street, Boston, MA 02108

Directions 

Phone

Call Board of Registration of Perfusionists at (800) 414-0168

Call Board of Registration of Perfusionists at (617) 973-0806

TTY Call Board of Registration of Perfusionists, TTY at (617) 973-0988

Online

Email Board of Registration of Perfusionists at Multiboard.Admin@mass.gov

Fax

(617) 973-0980

Related

• 267 CMR 3.00: Licensure requirements and procedures