TOBI Annual Meeting June 8-10, 2023

TOBI 2023 Annual Meeting
Attendee Registration Form

The cadaver lab is now full. Onlyregistrations for the two-day syposium on June 9-10 are available on this form.
Personal Information
First Name:*
Middle Initial:
Last Name:*
Select all degrees that apply. This will be printed on your name badge.*

MDDODPMNDPhDNPPARN
Organization:
Address:*
City:*
State:*
Zip:*
Phone:*
Cell:
Fax:
E-mail:*
----------------------------------------------------------------------
Demographic Information

Select all that apply to you.
Practice Setting:*

Office PracticeHospitalAmbulatory Surgery CenterUniversityNot Applicable
Practice Specialty:*

Spine/Pain ManagementSports MedicineOrthopedic SurgeryPhysical Medicine and RehabilitationNot Applicable
How did you learn about the meeting:*

Attended TOBI past meetingColleagueASIPPPostal Service MailerSocial MediaEmail BlastGoogle
----------------------------------------------------------------------
Complimentary Book Offer
If you have the complimentary book promotion code, please select which books you want to receive at the meeting registration desk. Enter coupon code after selecting your registration option.

Essentials of Regenerative Medicine in Interventional Pain Management.Interventional Techniques in Chronic Spinal Pain Edition 1Interventional Techniques in Chronic Spinal Pain Edition 2I would like the books but do not have a code.No Thank you
Payment Information

If completing registrations for multiple attendees, you need to complete a new form for each person.
The cadaver lab is now full, but you may still register for the two-day symposium on June 9-10.

My Products

2-Day Symposium Only$1,995.00

Full symposium access June 9-10 for physicians and mid-level staff.

2-Day Symposium (Fellows, Residents, Medical Students)$200.00

You must submit your fellowship, residency or medical school program contact information for verification to kavery@asipp.org.

Industry Representative (Non-Exhibitor) Individual$2,700.00

This registration is for individual industry reps who attend but do not support the meeting through sponsorships and exhibit fees.

Enter coupon

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

I agree to share my email with industry participants whose generous support helps make this meeting possible.*
I understand the cancellation policy list below.*
Time*

:HourMinutesAM/PM Option
Submission Date*

MonthDayYear
Date
Enter the message as it's shown*
CANCELLATION POLICY:

TOBI and ASIPP reserve 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 may be refunded minus a 3.5% processing fee up until May 8, 2023. Costs incurred by the registrants, such as airline or hotel fees or penalties, are the responsibility of the registrants. TOBI and ASIPP require a 30-day written notice of cancellation. Cancellations must be submitted in writing to kavery@asipp.org by May 8, 2023. Cancellations after May 8, 2023 but prior to May 25, 2023 will forfeit 50% of their registration fee + a 3.5% processing fee. No refunds can be made after May 26, 2023.
Should be Empty: