IPPS Understanding Pelvic Pain-Half Day Virtual Course Registration

Course Cost: $50.00 USD

IPPS is committed to advancing access to quality care and to work with patients to support them with their health-related goals. Some individuals living with pelvic pain may not have the resources to attend this virtual meeting. To that end we offer scholarships for individuals in need of financial assistance to attend this course. Scholarship funding is limited. To apply, please click here.
1. Title

Mr.Mrs.MissMs.Mx.Let me type
2. Name of individual attending the course*

First NameLast Name
3. Which of the following most accurately describe(s) you? (choose as many as you would like)*

FemaleMaleNon-binaryTransgenderIntersexI prefer not to sayLet me type
4. Email of the individual attending this course*
example@example.com
5. How did you hear about this course?*

Online AdvertisingPersonal invite from a providerFlyer from a medical officeEmail from a healthcare provider's officeFrom an IPPS MemberA friend/word of mouthPatient Advocate/support groupOther
6. I would be willing to share anonymously to a staff or board member what I thought about the course.*

YesNo
Which describes you best?

I currently have symptoms of pelvic pain.I care for someone who has symptoms of pelvic pain.
I would like to hear more about patient related resources in the treatment of pelvic pain.

YesNo
I would like to help IPPS raise awareness about pelvic pain management.

YesNo
I would be willing to assist in patient related research studies in pelvic pain.

YesNo

7. Payment for Course:

Understanding Pelvic Pain | Half Day Virtual Course - Saturday, May 31st, 11 AM - 3 PM ET

$50.00

I wish to make a donation to make it possible for someone who may have financial difficulty to attend this course.Donations are in increments of $50. In choosing the quantity below, this will increase your donation times $50 (i.e. Quantity of 2 would be a $100 donation, making it possible for 2 others to attend this course who may not otherwise be financially able to)

$50.00 Quantity
Item subtotal:$0.00

Total

$0.00

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

*Once you have purchased a registration you will receive a receipt of payment. Closer to the meeting you will receive a personal Zoom Link for you to attend the meeting. If you do not receive a link by May 30th, please email info@pelvicpain.org
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