Contacts
Board of Registration of Perfusionists
The Details of 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
- Download and complete the form, found below
- Mail completed form to:
Board of Registration of Perfusionists
239 Causeway St.
5th Floor, Suite 500
Boston, MA 02114
- Download and complete the form, found below
- 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
Address
250 Washington Street, Boston, MA 02108
Phone
Fax
(617) 973-0980