Interventional Techniques in IPM Cadaver Workshop October 21-22, 2023

ASIPP Interventional Techniques in IPM Cadaver Workshop Basic, Intermediate, or Advanced and Virtual Review Course

Lab will be held on October 21-22, 2023 in Memphis, TN. Virtual Review Course takes place on October 14 (online using Zoom).
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:*

MDDO
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Primary Specialty Certification:*

AnesthesiologyNeurologyPhysiatry
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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 Management
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Fellowship Training*

Pain MedicineSpine SurgerySports Medicine
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Years in Interventional Pain Management practice:*

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.
Caudal Epidural Injections*
Lumbar Interlaminar Epidural Injections*
Lumbar/Sacral Facet Joint Nerve Blocks*
Lumbar Facet Joint Interlaminar Injections*
Lumbar Facet Radiofrequency*
Lumbar/Sacral Transforaminal Epidural Injections*
Percutaneous Adhesiolysis*
Sacroiliac Joint Injections*
Lumbar Discography*
Percutaneous Lumbar Discectomy*
Cervical Interlaminar Epidural Injections*
Cervical Facet Joint Nerve Blocks*
Cervical Facet Joint Intraarticular Injections*
Cervical Facet Radiofrequency*
Cervical Discography*
Facet Joint Nerve Blocks*
Thoracic Interlaminar Epidural Injections*
Thoracic Facet Radiofrequency*
Thoracic Discography*
Stellate Ganglion Blocks*
Celiac Plexus Blocks*
Lumbar Sympathetic Blocks*
Hypogastric Plexus Blocks*
Trigeminal Nerve Blocks*
If Registering for Cadaver Workshop:
Choose Cadaver Workshop Level*

BasicIntermediateAdvanced
Payment Information

The cadaver workshop has limited spaces - early registration is encouraged.

Cadaver Workshop and Virtual Review Course -- Member$3,500.00

Virtual review course will take take place on Saturday, October 14 at 8am central time.

Cadaver Workshop and Virtual Review Course -- Non-Member$3,800.00

Virtual review course will take take place on Saturday, October 14 at 8am central time.

Cadaver Workshop Only - Member $3,200.00

Cadaver Workshop Only - Non-Member$3,500.00

Virtual Review Course Only -Member$400.00

Virtual review course will take take place on Saturday, October 14 at 8am central time.

Virtual Review Course Only - Non-Member $600.00

Virtual review course will take take place on Saturday, October 14 at 8am central time.

Resident/Fellow Special Offer for Cadaver Workshop and One-day Virtual Review Course $1,000.00

There are a limited number of spaces for this discount. If registering as a Resident or Fellow, please provide proof of program participation to crogers@asipp.org Your registration will not be approved until program documentation is received and verified.

Resident/Fellow Special offer for Virtual Review Course Only - Resident/Fellow$50.00

If registering as a Resident or Fellow, please provide proof of program participation to crogers@asipp.org

Total $0.00

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CANCELLATION POLICY FOR LAB:

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 September 21, 2023 but prior to October 7, 2023 will forfeit 50% of their registration fee. No refunds can be made after October 7, 2023.
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ASIPP Interventional Techniques in IPM Cadaver Workshop Basic, Intermediate, or Advanced and Virtual Review Course