ASIPP 2026 Cadaver Lab Qualifying Form

ASIPP 2026 Cadaver Lab Qualifying Form
Thank you for registering for ASIPP 2026. You were directed to this form because you registered for the cadaver lab option.

Please check your email for your meeting registration confirmation with payment receipt, and additional information on hotel, CMEs and more.
Course Options

Full Course Descriptions will be added later. Stations have limited capacity so please complete this form immediately to guarantee your first preference section.
- Interventional Techniques - Basic (Full - closed to new registrations)
- Interventional Techniques - Intermediate (Full - closed to new registrations)
- Minimally Invasive Spine Interventions
- Regenerative Medicine - Beginner
- Regenerative Medicine - Intermediate (not approved for fellows)
- Regenerative Medicine - Advanced (not approved for fellows)
Personal Information
First Name:*
Middle Initial:
Last Name:*
Select all degrees that apply. This will be printed on your name badge.*

MDDO
Organization:
Address:*
City:*
State:*
Zip:*
Phone:*
E-mail:*
Cadaver Lab Course Preference

You must select a preferred section below. Attendees who do not make a selection below risk not being placed in their preferred section.

Each track comes with a complimentary live 8-hour didactics webinar. Regenerative tracks will have a regenerative and longevity medicine webinar. All remaining tracks will recive a IPM techniques webinar. Webinars will be held before the workshop.
Select Your Desired Section for the Lab:*

Minimally Invasive Spine InterventionsRegenerative Medicine - BeginnerRegenerative Medicine – IntermediateRegenerative Medicine - Advanced
Cadaver Lab Qualification Information

You must select a preferred section below. Attendees who do not make a selection below risk not being placed in their preferred section.
Registrants who select ADVANCED without the appropriate training will be moved to another section. Please select all that apply to you. If you select NONE OF THESE, you will be moved to beginner or intermediate. Or you may go back in the form now and select another option.

NeurosurgeonInterventional Pain PhysicianPhysiatristSpine FellowNone of these
Primary Specialty Certification:*

AnesthesiologyNeurologyPhysiatryOrthopedicOther
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 ManagementOther
Fellowship Training:*

Pain MedicineSpine SurgerySports MedicineOther
Years in Interventional Pain Management Practice:*

01-56-1010 or more
Number of Years experience in Regenerative Medicine:*

01-56-1010 or more
INDICATE THE NUMBER OF PROCEDURES PERFORMED DURIG THE PAST YEAR:
Soft Tissue and Ligament Injections *
Shoulder Injections*
Elbow Injections*
Wrist Injections*
Hip Injections*
Knee Injections*
Ankle Injections*
Sacroiliac Joint Injections*
Caudal Epidural Injections*
Lumbar Interlaminar Epidural Injections*
Lumbar/Sacral Transforaminal Epidural Injections*
Lumbar/Sacral Facet Joint Nerve Blocks*
Lumbar Facet Joint Intraarticular Injections*
Lumbar Discography*
Pudendal Nerve Blocks*
Ultrasound Guided Injections*
Date*

MonthDayYear
DateHourMinutesAM/PM Option
Enter the message as it's shown*
Should be Empty: