Online PD Re-certification Form

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This form allows submission of a PD Recertification Application online with payment of applicable recertification fee ($150/Member and $400/Lapsed Member*) by credit card.
*Lapsed Member fee includes ASDIN membership for remainder of the membership year from date of recertification application.

If there are any issues in the upload/submission of this form, please use the following uplink -

https://spaces.hightail.com/uplink/asdin and notify the ASDIN office at lfox@asdin.org.

DO NOT SEND PATIENT IDENTIFIERS IN ANY OF THE PAGES SUBMITTED. PLEASE REVIEW CASE/PROCEDURE NOTES AND CASE LOG TO ASSURE THAT PATIENT NAMES ARE REMOVED. YOUR APPLICATION WILL BE RETURNED TO YOU AND WILL NOT BE PROCESSED UNTIL AN APPLICATION WITHOUT PATIENT IDENTIFIERS IS SUBMITTED.

First Name *
Last Name *
Email Address *
Are you currently certified by ASDIN in PD? *Applicants must be currently certified by ASDIN in HVA and actively doing interventional procedures.	Yes No
Upload Completed Application *Applicant should only include the Application itself (pp. 5-6) in this upload.
Upload Letter of Confirmation by Applicant *Applicant should include the Letter of Confirmation by Applicant - p 7 of application - here.
Upload Case Log *Applicants should upload only the Case Log in this file. See sample Case Log on page 8 of application.
Upload Case Note(s) *Applicants should upload the required Case/Procedure Note(s) in this file. One (1) each per technique for which applicant is requesting.
Upload CME Documentation *Seven (7) hours of Continuing Medical Education in vascular medicine, hemodialysis access, radiation safety or interventional procedures obtained within the past three (3) years.

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If there are any issues in the upload/submission of this form, please use the following uplink -