Clone of Strategies of Successful Practice Management in IPM Review Course November 1, 2025

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

----------------------------------------------------------------------

Primary professional practice setting (please check all that apply):

----------------------------------------------------------------------

Course Fees and Payment Information

Physician Member$262.50

Discounted from $350. Savings good through January 5.

Physician Non-Member$300.00

Discounted from $400. Savings good through January 5.

Non-Physician Member$187.50

Discounted from $250. Savings good through January 5.

Non-Physician Non-Member$225.00

Discounted from $300. Savings good through January 5.

Resident/Fellow$37.50

Discounted from $50. Savings good through January 5.

Medical Student$37.50

Discounted from $50. Savings good through January 5.

Recorded Version Only (non-CME) $200.00

Will be available after the live course airs

DCCPM Competency Certification Online Examination$500.00

This examination will take place online on Saturday, Feb. 7 at 10:00 am CST. Please email crogers@asipp.org for your preferred testing date.

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

CANCELLATION POLICY:

Please enter the letters to the right before submitting form:*

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; however, registration fees would be refunded.

Virtual meeting registrations cannot be refunded after registration has been activated.