Become a Member

This form is for both regular and professional (diplomate or Fast-Track candidate) new members. If you are applying for Fast-Track and are already a regular PINA member, please use our membership reinstatement form to renew at (upgrade to) the professional level before filling out your Fast-Track application. PINA will refund you any duplicate payment of dues.

New member registration form

Please fill out and submit the form below to become a PINA member.
If you need more information about membership, see our membership overview page.
You must have a PayPal account, or create one when submitting the form - you can pay with either credit card or funds in your PayPal account.
This is a subscription membership that will renew automatically every year with a PayPal billing.
You can cancel the subscription at any time via your PayPal account if you no longer wish to be a member.
  • Choose a user name for your PINA login.
    NOTE - after your payment is processed, a link to set your member login password will be e-mailed to you!
  • When is your birthday?
    What kind of PDC did you attend?
    Checking this box means you are giving permission for us to share your e-mail with other PINA members wishing to organize a hub in your area.
  • $0.00
    This is a subscription membership that will auto-renew yearly. You must have a PayPal account, or create one as you make this payment.
    REMINDER - after your payment is processed, a link to set your member login password will be e-mailed to you!
  • This field is for validation purposes and should be left unchanged.

If you are unable to register online, you can print out our Membership Application Form and send it with payment to the address on the form.