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Name and Credentials:

e-mail Address:

Postal Address:

City, State, & Zip Code:

Phone/Fax:

Preferred e-mail Address:

 

 

Educational Information (list most recent first)

Name of Institution	Location	Year Degree Conferred	Degree	Major

 

 

 

Employment Information (Limit to Last 5 positions)

Name of Institution or Agency	Location	Title	Dates (Years) of Employment

 

List Relevant Publications (Limit to 6)

 

 

 

List Relevant Presentations (Limit to 6)

 

 

 

List Relevant Research (Include funding sources & amount if applicable)

 

 

Check (√) the general types of manuscripts

that you are willing to review.

Content Area
News Articles
Opinion Articles
Concept or Issue Papers (including white papers and review of literature)
Scholarly Papers (including projects and case studies)
Industry Papers
Education Articles
Original Research Articles
International Papers

 

 

Check (√) the VAD content areas in which

you have expertise

Content Area
Equipment
Technology
Products
Nursing Care
Medicine/Medical Care
Allied Health Approaches
Industry
Legal and Ethical Issues
Patient Care
Care and Maintenance
Insertion
Device Selection
Complications/Adverse Events
Adult Interventions
Pediatric Interventions
Geriatric Interventions
Critical Care Interventions
Oncology
Community/Home Health
International Health Care
Quality of Life
Other: Please Specify _________________________ _________________________

 

Are you willing to mentor one (1) beginning or international author per year?

YES ___     NO ___

 

Indicate how many manuscripts per year you are willing to review.

 

___1-2

___3-4

 

Thank you for considering being a reviewer for the

Journal of the Association of Vascular Access.

 

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