Annual membership (January to December) to the Arizona Simulation Network is $60/year. Would you like to proceed with this membership form? If selecting yes, you will receive an email notification with a link to our PayPal site.

Yes

Please List Your Employer

Donor Network of Arizona

List Current Job Titles.

Donation Training and Development Manager

What is your legal state of residence?

AZ

Please share your experience with simulation

Extensive experience. I am a current AHA BLS/ACLS/PALS instructor. Worked with Banner Health in this capacity for many years. Adjunct Faculty with A.T. Still University for 12 years, creating and facilitating simulation skills labs for PA students. Grant research assistant director using high fidelity simulation in training dental professionals. I completed my Ed.D Dissertation on simulation education for PA Students.

Photo disclaimer: I understand that photographs, video and/or audio taken of me may be published by Arizona Simulation Network for educational, and marketing purposes. I understand that I will not have the opportunity to approve the photographs, video and/or audio in advance, and I relinquish and give to Arizona Simulation Network all rights, title, and interest I may have in the finished pictures or negatives. I hereby release Arizona Simulation Network from any and all claims, demands, or causes of action that I may hereafter have against Arizona Simulation Network whether for libel, invasions of privacy, or anything else, by reason of the use of the photographs, video and/or audio described above or the information that is published to accompany the photographs, video and/or audio.

I agree

To Complete your membership process, please go back to the Home Page and Click on Annual Membership Dues PayPal Link in the lower right corner of the page.

I understand