ASPN 2024 Annual Conference Registration
Name
*
First Name
Last Name
Credentials
*
NPI Number
*
Put 0 if not applicable.
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Area of Residency
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Anesthesia
PM&R
Industry
Orthopedic Surgery
Neurosurgery
Psychiatry/Psychology
Other
Practice Type
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Academic
Private Practice
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Training
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Are you a Fellow/Resident?
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Yes
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My Products
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Add Ons
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ASPN Member
Early Bird Rate - Original $500
$
400.00
Non Member
Early Bird Rate - Original $600
$
500.00
APP/Office Staff
Early Bird Rate - Original $300
$
200.00
Young Innovators/Fellows/Residents
$
Free
ASPN Military Member
$
350.00
Non-Sponsor Industry Badge
$
750.00
Add Ons
Practice Management Course
Thursday, July 11th, 1:00-5:00 PM
$
100.00
APP Break Out Course
Friday, July 12th. Included with cost of registration.
$
Free
Business and Law Break Out Session
Saturday, July 13th.
$
100.00
ASPN Charity Reception donation
$50 donation recommended.
$
50.00
ASPN Charity Reception
$50 donation recommended.
$
Free
5K Charity Run - Individual Registration
Includes T-shirt, please put shirt size in section below.
$
50.00
5K Charity Run - Team Registration
$50/team member. Includes T-shirt for each team member, please put shirt sizes in section below.
$
50.00
Quantity
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Practicing Physician Round Table and Ultrasound Workshop
Thursday, July 11th. Included with the cost of a paid registration. This lab is for practicing physicians only.
$
Free
Fellow's Round Table and Ultrasound Workshop
Thursday, July 11th. Included with the cost of a paid registration. This lab is for practicing physicians only.
$
Free
Payment Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
I want to be added to the waitlist for...
Practicing Physician Round Table and Ultrasound Workshop
Fellow's Round Table and Ultrasound Workshop
Lunch Options
Please select your choice of lunch to attend for both Friday & Saturday.
Friday, July 12th Lunch Choice
*
Abbott
Boston Scientific: Transforming the Future of Interventional Pain:Next-Gen Intracept™ Procedure and Automation in SCS Therapy - Speakers: Jad Khalil, MD, Ajay Antony, MD, Ramana Naidu, MD, and Louis J. Raso, MD
Vertos Medical: A New Era for IPM: elevate your practice & Your Community through mild - Speakers: David Dickerson, MD, Peter Pryzbylkowski, MD, Rebecca Sanders, MD, and Zohra Hussaini, MSN, FNP-BC, MBA
Not attending lunch
Saturday, July 13th Lunch Choice
*
Biotronik Neuro
Scilex Holding Company
Not attending lunch
Dietary Restrictions
5K Charity Run - Individual Registration Shirt Size
Please Select
XS
S
M
L
XL
2X
3X
SHIRT IS ONLY INCLUDED WITH PAID REGISTRATION FOR THE 5K CHARITY RUN.
5K Charity Run - Team Name
5K Charity Run - Team member names and shirt sizes (ex: John Doe - Large). Please add a line for each team member registered with name and shirt size.
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