Medical Perfusion Application Form
To be eligible for admission into Medical Perfusion, you must be a consultant or trainee in Anaesthesia, Intensive Care or Cardiac Surgery.
What is your specialty?
None of the above
You are ineligible for this program.
Are you an Australian or International applicant?
This program has 2 different options - eLearning; or eLearning + Practical Training. Which are you interested in studying?
eLearning + Practical Training
You can enrol & study in the full course (4 subjects) simultaneously, or 1 subject at a time. Please indicate your enrolment preference:
NAMPA / ASMP Member?
You must be an ASMP member to be eligible for the eLearning + Practical Training course. On submission of this application form, ASMP will contact you directly.
To be eligible for a discount, you can complete your membership subscription PRIOR to completing this application. You can apply for ASMP membership via the
Name of degree
Name of fellowship
CV (Please click the 'Browse' button below to select a file)
Academic Transcript (Please click the 'Browse' button below to select a file)
Letter from Workplace (Please click the 'Browse' button below to select a file)
Photo of Passport (Please click the 'Browse' button below to select a file)
New South Wales