Petition for retired perfusionist status

What you need

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

By mail +

1. Download and complete the form, found below

2. Mail completed form to:

   
   Board of Registration of Perfusionists
   100 Cambridge St., 19th Floor
   Boston, MA 02114-2509

By fax +

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

Downloads

Retirement Application (PDF), Open PDF file, 258.04 KB (English, PDF 258.04 KB)

Contact

Board of Registration of Perfusionists

+

Address

100 Cambridge St., 19th Floor, Boston, MA 02114-2509

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