Fellow Membership Application

Fellow Membership Application

Name
MM / YYYY

Business Name and Address

Please list the hospital or business name of your employer.
Your title
Business Address

Home Address
For Correspondence Use My:

Nominating and Seconding Fellow Members

Nominating Fellow
Address
Please include the address, phone number and email address of your nominating Fellow.

First Seconding Fellow
Please include the phone number and email address of your first seconding Fellow.

Second Seconding Fellow
Please include the phone number and email address of your second seconding Fellow.

Are you currently a full time clinical perfusionist?

Attendance and Participation

Please use the check boxes below to denote if you have attended an annual AACP meeting, presented a paper, and/or been a moderator (panel session or FSC).
Attendee
Check the Academy Meetings when you were in attendance (in-person)
Paper Presenter
Check the Academy Meetings when you presented a scientific paper
Moderator
Check the Academy Meetings when you were a moderator
Additional Participation
Check the Academy Meetings when you participated in an alternative way

The purpose of The Academy is to encourage and stimulate investigation and study which will increase the knowledge of cardiovascular perfusion. Please state, in a short concise manner, how you have contributed and plan to continue to contribute to The AACP if elected to Fellow Membership.

For each organization, use a separate line to list the name of the organization, the date when you became a member and any positions held.

Upload Documents

Please upload the required documents: Curriculum Vitae, letter of nomination, and two seconding letters of support.
Max. file size: 128 MB.
Max. file size: 128 MB.
Letter is provided by your Nominating Fellow. If you have already received it from them, please upload it here.
Max. file size: 128 MB.
Letter of support from your first Seconding Fellow. If you have already received it from them, please upload it here.
Max. file size: 128 MB.
Letter of support from your second Seconding Fellow. If you have already received it from them, please upload it here.

Upon receipt of your completed application, CV and letters of nomination, your information will be sent to the members of the Membership Committee for review. Someone from that committee may contact you prior to or at the upcoming meeting. If the Membership Committee elects to recommend you for Fellow membership, your membership will be voted upon at the Closing Business Meeting of the upcoming meeting of The Academy. You will be contacted after the meeting to inform you of the status of your membership. If you are voted in at the Closing Business Meeting, you will be recognized and inducted at the induction dinner the year following acceptance of your fellow status. If you have any questions, please contact the National Office at 610-285-2329 or office@theaacp.com.
I am aware that this application must be accompanied by one letter of nomination and two letters of seconding support by Fellow and/or Senior Members of The Academy, as well as my Curriculum Vitae. I agree that The Academy's Council, after approval of the Membership Committee, may submit my application for approval or disapproval to the Fellow Membership of The American Academy of Cardiovascular Perfusion at the Annual Business Meeting of The Academy. I agree to pay $25.00 filing fee with the submission of this application. I further understand that my continued Fellow Membership is dependent upon participation in The Academy according to the Constitution and By-Laws of The Academy.
I hereby certify that the information contained in this application is true and correct.

After you click on the Submit button below, you will be directed to PayPal where you can pay the application fee.

American Academy of Cardiovascular Perfusion Fellow Application Checklist

(Must be completed to be considered a complete application.)
Completed Application
Updated CV
Have you met the minimum requirements?
Requested Nominating Letter from Fellow or Senior Member
Requested Supporting Letter of Nomination from Fellow or Senior Member
Requested Second Supporting Letter of Nomination from Fellow or Senior Member
Application Fee Paid
Submit signed and dated application and all supporting material AT LEAST Two months prior to the AACP meeting