EIN - Become an EIN Member

EIN membership is a benefit of IDSA or PIDS membership; no additional dues are required.

EIN Membership Requirements

You Must:	1. be an infectious diseases physician
	2. see patients on a regular basis
	3. be willing to complete periodic brief surveys
	4. be an IDSA or PIDS member

If you have questions about the EIN, feel free to contact us.

Please complete the form below to join the EIN. The Program Coordinator will contact you shortly with membership materials.

*First Name:
Middle Initial:
*Last Name:

Degree(s):

Current Fellow

Primary Practice Type (select all that apply):
    Private practice:
         Solo ID Specialist
         Solo ID Specialist within Multispecialty Group
         Member of ID Group
    Employed by:
         University hospital
         Non-university teaching hospital
         City/County hospital
         Community hospital
         Veteran's hospital or the Department of Defense
    Other, specify:

Do you see (select one):

Are you a member of (select one):

Contact Information

*Institution or Practice Name:
Street address 1:
Street Address 2:
City:
State:
Zip Code:
Country:
Work Phone:
Work Fax:
*Email:

Additional questions or comments:

* = required field