Application Form

Pay Membership Fee:

Thank you for your interest in joining the Professional Liability Defense Federation. Membership requires that applicants devote most of their professional time, related to malpractice claims, to the defense of such claims. Membership is free for claims professionals. The annual membership fee is $250.00 for defense attorneys. Please note that $25.00 of each dues payment is separately allocated to the PLDF Amicus fund.

If you have questions please write to cjensen@PLDF.org or call us at (612) 481-4169.

**PLEASE MAKE SURE TO FILL OUT FORM BELOW COMPLETELY BEFORE PROCEEDING TO PAYMENT PAGE**

First Name *
Last Name *
Employer *
Job Title / Description *
Address *
City *
State *
Postal Code *
Country *
Telephone *
Fax
E-mail Address: *
If counsel, jurisdictions of admission and bar numbers (for CLE expediency)
Specific Committee Interests *
Specialties

**Payments made to PLDF are not deductible as a charitable contribution and no lobbying expenses are being incurred.