ASIPP 2026 Cadaver Lab - PNS or SCS

ASIPP 2026 Cadaver Lab PNS or SCS Qualifying Form
Thank you for registering for ASIPP 2026. You were directed to this form because you registered for the cadaver lab option for either PNS or SCS. Fellows and residents are not eligible for PNS or SCS.

PNS Stations are now full.

Please check your email for your meeting registration confirmation with payment receipt, and additional information on hotel and other important meeting information.
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:*
See description above and select your preferred station below:*

SCS Stations
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:

ASIPP 2026 Cadaver Lab PNS or SCS Qualifying Form