Membership Application

required fields are noted with *

Contact Information

/ /   MM/DD/YYYY format

Login Information

Must be at least 8 characters long.

* Password is case-sensitive. Must be at least 8 characters long.


Preferred Mailing Address

The address to receive the journal, newsletter, and annual meeting information.


Patient Access Information

Appears in “Find a Pediatric Dermatologist” search results.

* Would you like to appear in the “Find a Pediatric Dermatologist” search results?


Education and Professional Affiliations

Enter NA if it does not apply to you.

Specialty Boards

Appears in “Find a Pediatric Dermatologist” search results. Please use the following abbreviations where applicable:

ABD – American Board of Dermatology
ABP – American Board of Pediatrics

Current Hospital Affiliations

Current Medical School Affiliations

Training Program Verification

Residents & Fellows: All applicants must supply a verification letter from their Program Chair confirming their current status in a training program. This also applies to medical students applying for SPD membership at the Resident/Fellow level.

To expedite the application process, we suggest that Resident & Fellow applicants select the “Check here to request a verification letter by email” box to the right.

Verification letters to support your application should be:

  • emailed to
  • faxed to 317-205-9481
  • or mailed to:
    • SPD
      8365 Keystone Crossing
      Suite 107
      Indianapolis, IN 46240

Program Chair

* Member Profile

Please choose a description from the list below that best describes you.

* Initiation and First Year Membership Fee

All fees are payable in US funds drawn on a US bank.

Practicing Physicians in developing countries must have written committee approval.

The membership fee covers an initiation fee of $100.00, the first year's dues of $70.00, and the rest is the yearly subscription rate for Pediatric Dermatology, SPD’s Journal. For physicians outside the U.S., the increased fee is to cover the cost of additional postage.

Research Surveys

SPD supports the collection of adequate data from members to help facilitate important research in pediatric dermatology. To assist that objective, the SPD circulates electronic surveys from time to time as a form of research collaboration. These surveys are reviewed and approved by the SPD’s Research Committee prior to distribution. All members receive these electronic surveys by default, however if you would like to opt out, please select “No” in the drop down menu below.

I would like to receive SPD-approved research surveys:

Note: Opting out of receiving SPD-approved research surveys will not prevent you from receiving other emails from the SPD.

PeDRA Membership Dues

Note: If you choose this option, you will see separate credit card charges for SPD and PeDRA membership.

Payment Information


3 or 4 digit verification code on card

Billing Information

Please enter the billing information that is on record for this credit card.

If it is the same as above, please check the box and leave these fields empty.

When you click Review you will be presented with a review of your information along with the total amount to be charged.
Your application will not be complete until you click Submit on the next page.