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Striving to be the international multidisciplinary leader in the advancement of pediatric sedation by promoting safe, high quality care, innovative research and quality professional education.

Striving to be the international multidisciplinary leader in the advancement of pediatric sedation
by promoting safe, high quality care,innovative research and quality professional education

In order to submit a Pediatric Sedation Service Center of Excellence Application you must have a login ID.

To obtain a login ID please fill out the following information.

Your login ID will be the PRIMARY CONTACT'S EMAIL ADDRESS you enter into this form.

Fields marked with * are required for all applicants.

Fields marked with ** are required for nonmember institutions ONLY.

Institution Information

Member Institution (please select if applicable)
Nonmember Institution (if not listed above)
If you entered a nonmember institition above, please complete the following address information.
Member institutions, please skip to Primary Contact below.
Address 1 **
Address 2
City **
State/Province (leave blank if non-US/Canada)
Postal Code / ZIP **
Country **
Website **
Do not include http://


Primary Contact

First Name *
Last Name *
Title (MD, PhD, etc.)
Address 1 *
Address 2
City *
State/Province (leave blank if non-US/Canada)
Postal Code / ZIP *
Country *
Phone *
Email *
THIS WILL BE YOUR LOGIN USERNAME
Retype to Confirm Email *


Secondary Contact

First Name *
Last Name *
Title (MD, PhD, etc.)
Phone *
Email *