July 2021 Lumbar Endoscopic Spinal Decompression Review Course

Cadaver Workshop Venue
Medical Education and Research Institute
44 South Cleveland, Memphis, TN 38104 |(901) 722-8001| (800) 360-6374

Room Block for Cadaver Workshop:
Guest House at Graceland
3600 Elvis Presley Blvd.
Memphis, TN 38116

**This course is open to physicians only*

Personal Information:

First Name:*

Middle Initial:

Last Name:*

Organization:

Address:*

City:*

State:*

Zip:*

Phone:*

Cell:

Fax:

E-mail:*

Please answer all of the following questions:

Medical Degree:*

MDDOPhDOther

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Primary Specialty Certification:*

AnesthesiologyNeurologyPhysiatryOther

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Pain Medicine Subspecialty Certification*

American Board of AnesthesiologyAmerican Board of Interventional Pain PhysiciansFellow of Interventional Pain PracticeAmerican Board of Pain MedicineCompetency in Regenerative MedicineCompetency in Interventional Pain ManagementOther

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Fellowship Training*

Pain MedicineSpine SurgerySports MedicineOther

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Years in Interventional Pain Management practice:*

01-56-10More than 10

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Number of Years Experience in Lumbar Spinal Endoscopic Decompression*

01-56-10More than 10

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Please indicate the total number of procedures during the past year for each of the procedures below.

Percutaneous disc decompression (Disc FX/Perculine)*

Lumbar Endoscopic Medial Branch transection (rhizotomy)*

Cervical Endoscopic Facet Debridement*

SI Joint Endoscopic Denervation*

Transforaminal Endoscopic Discectomy*

Tranforaminal Endoscopic Foraminoplasty*

Interlaminar Endoscopic Discectomy*

Interlaminar Endoscopic Lateral Recess Decompression*

Exforaminal Transforaminal Endoscopic Discectomy*

Payment Information

Cadaver lab has limited spaces however the review course is unlimited. Early registration is encouraged.

Cadaver Workshop and Review Course -- Member$4,650.00

Cadaver Workshop and Review Course --Non-Member$4,950.00

Virtual Review Course Only - Member $1,000.00

Virtual Review Course Only - Non-Member$1,100.00

Total $0.00

Credit Card

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Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

CANCELLATION POLICY:

ASIPP reserves the right to cancel this course upon reasonable notice and will assume no financial obligation to registrants for cancellation for reasons beyond its control. Registration fees will be refunded, however, costs incurred by the registrants, such as airline or hotel fees or penalties, are the responsibility of the registrants. ASIPP requires a 30-day notice of cancellation for cadaver workshops. Cancellations for cadaver workshop after July 1, 2021 but prior to July 17, 2021 will forfeit 50% of their registration fee. No refunds can be made after July 17, 2021.

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