Michigan Perfusion Society Membership Application First and Last NameHome AddressCity, State, Zip CodeCell PhoneEmailYears in Perfusion Hospital Affiliation(s)Do you consent to having your information in the Michigan Perfusion Society Directory?YesNoMembership ClassClass A: Practicing Perfusionist ( Annual Dues $25)Class A Emeritus Voting: Retired from Perfusion (Annual Dues $25)Class A Emeritus Non-Voting: Retired from Perfusion (Annual Dues $0)Class B: Out of State Practicing Perfusionist (Annual Dues $25)Class C: Current Student of Perfusion (Annual Dues $0)Membership TypeNewRenewal (no lapse in membership)Reinstatement (lapse in membership)I agree to abide by the rules and regulations of the Michigan Perfusion Society that may be enforced from time to time and pay all the dues as applicable. I also agree that my membership may be terminated immediately if the Michigan Perfusion Society Board concludes that I have violated any of the societies rules or regulations outlined in the Michigan Perfusion Society Bylaws.AgreeDo No Agree Send Me a Copy of My Application Click Here to Review the Michigan Perfusion Society Bylaws
