V IR T U A L M E E T IN G COMPREHENSIVE AND PRACTICE REHABILITATION FOR THE SURVIVAL OF IPM ASIPP® ANNUAL MEETING 2020 SEPTEMBER 4-6, 2020 | 19.75 AMA PRA CATEGORY 1 CREDITS ™ 13 KEYNOTE SPEAKERS | 20 DISTINGUISHED SPEAKERS | OVER 1000 ATTENDEES

DISTINGUISHED SPEAKERS COURSE MEETING DIRECTORS SPECIALS l Early bird rates through August 5, 2020 l More than 90% Off Meeting Fee for Fellows/Residents LAXMAIAH MANCHIKANTI, MD BOARD CHAIRMAN AND CEO, ASIPP®

VI RTUAL ROBERT LASZEWSKI VANILA M. SINGH, MD BRET SCHER, MD KEVIN PHO, MD PRESIDENT, HEALTH CLINICAL ASSOCIATE LOW CARB CARDIOLOGIST PHYSICIAN, MEDIA HIGHLIGHTS POLICY AND STRATEGY PROFESSOR, ANESTHESIOLOGY, AND HOST OF THE DIET COMMENTATOR, PUBLIC ASSOCIATES, LLC PERIOPERATIVE AND PAIN DOCTOR PODCAST SPEAKER, AND AUTHOR. l Live Sessions AT STANFORD FOUNDER AND EDITOR OF KEVINMD.COM l Interactive Q/A UNIVERSITY HAROLD CORDNER, MD PRESIDENT, ASIPP® l On Demand After September 6 l Networking & Private Meetings l Video Calls/Text Chat l View Live Product Demos l Schedule Vendor Meetings l Revisit Exhibit Hall After SHERI ALBERS, DO FIRST EXECUTIVE Meeting Ends VICE PRESIDENT, ASIPP® SUSAN BLANK, MD SHALINI SHAH, MD SUNNY JHA, MD l Fully Staffed Exhibit Booths GABOR B. RACZ, MD PRESIDENT OF GEORGIA CHAIRMAN EMERITUS UNIVERSITY OF CLINICAL ASSISTANT l Virtual Help Desk SOCIETY OF ADDICTION OF THE DEPARTMENT OF IRVINE, DEPARTMENT PROFESSOR OF ANESTHESIOL- MEDICINE AND CEO OF ATLANTA ANESTHESIOLOGY AND OF ANESTHESIOLOGY & OGY, KECK SCHOOL OF MEDICINE HEALING CENTER AND ATLANTA CO-DIRECTOR OF PAIN PERIOPERATIVE CARE VICE- OF USC CURRENT WELLNESS CENTER SERVICES, TEXAS TECH CHAIR (PAIN) TOPICS DEVI NAMPIAPARAMPIL, MD DIRECTOR-AT-LARGE, ASIPP® l IPM Interfacing with Covid l Future of Health Care Reform l Managing Your Online Reputation l Marketing Playbook in New Economy SUDHIR DIWAN, MD l Chronic Pain and RANDY ALVAREZ J. MATTHEW ANDRY, MD BRIAN BRUEL, MD PAMELA MCPHERSON, MD IMMEDIATE PAST PRESIDENT, ASIPP® Metabolic Health FOUNDER, THE WELLNESS HOUR PRESIDENT OF ANDRY PRESIDENT, TEXAS PAIN SOCIETY ASSOCIATE PROFESS0R OF MEDICAL SERVICES PSYCHIATRY AND BEHAVIORAL l Pathophysiology of Controlled MEDICINE, LSU MEDICAL CENTER Substance Use

CONTACT AMOL SOIN, MD Meeting Web Site: PRESIDENT-ELECT, ASIPP® asippannualmeeting.com CONFERENCE Meeting Information: ADVISORY 270-554-9412 x4210 ANNU NAVANI, MD TAMMY DANN, MD DEBORAH TRACY, MD JUDITH BLASZCYZK, MD [email protected] COMPREHENSIVE SPINE AND PAIN EVALUATION & DIRECTOR AT LARGE, ASIPP® AUDITING FOR COMPLIANCE COMMITTEE SPORTS CENTER AND EDUCATION, INC. Laxmaiah Manchikanti, MD Abstract Information: MANAGEMENT CENTER OF OHIO INSTITUTE OF INTERVENTIONAL PAIN MANAGEMENT Sudhir Diwan, MD 270-554-9412 x4230 Rick Buenaventura, MD [email protected] Harold Cordner, MD Sheri Albers, DO A MUST ATTEND VIRTUAL MEETING Brian Bruel, MD Miles Day, MD Max Eckman, MD AMERICAN SOCIETY OF INTERVENTIONAL PAIN Vincent Galan, MD THE VOICE OF INTERVENTIONAL PAIN MANAGEMENT David Gale, MD 81 LAKEVIEW DRIVE, PADUCAH, KENTUCKY 42001 | PHONE: 270-554-9412 | FAX: 270-554-5394 | WEB SITE: www.asipp.org | EMAIL: [email protected] Devi Nampiaparampil, MD Amol Soin, MD ASIPP® 2020 ANNUAL MEETING SEPTEMBER 4-6, 2020 | VIRTUAL MEETING

Must Attend Virtual Meeting Thank you for your patience following the postponement of the (ASIPP®) ANNUAL MEETING 2020 due to COVID-19 and rescheduling for September 4-6 as a virtual meeting.

VIRTUAL BENEFITS

The American Society of Interventional Pain Physicians’ (ASIPP®) Annual Meeting 2020 will take place virtually September 4-6, 2020. The theme is ‘Comprehensive Physician and Practice Rehabilitation for the Survival of IPM’ and is brought to you in collaboration with the Texas Pain Society.

This must-attend interventional pain management meeting agenda is Revised, Current, and offers Relevant Topics Covering: COVID-19, Economics, Burnout, Social Media, Metabolic Health, Regulatory Issues, and Advances in IPM. The meeting offers you virtually every benefit you would receive from an on site meeting, including great learning and networking opportunities. You will have even more time to visit with exhibitor representatives in their virtual booths to learn about cutting-edge products and services.

ASIPP® always raises the standard for continuing education programs in Interventional Pain Management by offering exciting, educational, and enlightening lectures and panel sessions. Other great benefits include no travel expenses and more time in the office with your patients.

DISTINGUISHED LECTURE SERIES

There are two highly respected Distinguished Lecture Series. The Raj-Racz Distinguished Lecture Series has keynotes from Laxmaiah Manchikanti, MD on Survival of IPM During and After Concurrent Epidemics: COVID-19, Opioid, Evidence-Biased Medicine, Reimbursement Cuts, and Onerous Regulations. The Manchikanti Distinguished Lecture Series is pleased to have keynote Robert Laszewski who will be speaking on evolving concepts for the future of health care reform. His session will be followed by a keynote panel discussion involving several distinguished faculty, including representatives from Farragut Partners, one of Washington’s top government relations firms. Joshua Hirsch, MD will do the introduction to the Manchikanti Distinguished Lecture Series. Dr. Hirsch is Vice Chief of Interventional Care, Massachusetts General Hospital and Associate Professor, Harvard Medical School.

KEYNOTE SPEAKERS

Randy Alvarez, founder of The Wellness Hour, begins lectures Friday morning with the topic of marketing for success in tough times. The Wellness Hour airs each week on TV in approximately 70 million homes across the and Canada, featuring some of the nation’s leading medical doctors, dentists, and other licensed health practitioners.

Amol Soin, MD, MBA; Devi Nampiaparampil, MD; Shalini Shah, MD; and Pamela McPherson, MD will address moving forward after Covid-19: dealing with the financial impact, how it changes IPM practices, how it affects physicians and mid-level practitioners, its impact on healthcare reform and more. Vanila Singh, MD will discuss how best practices in IPM have changed. Susan Blank, MD will discuss the pathophysiology of controlled substance uses.

And in the times we now live, private practice physicians need help managing their online reputations. Kevin Pho, MD, a widely known expert, will help fellow physicians navigate this ever-evolving landscape. Sheldon Jordan, MD will discuss the brain’s impact on the aging effects, and about how to reset the process.Bret Scher, MD, a low carb cardiologist, will wade through facts and fiction about the use of low carb diets with patients. Gurpreet Padda, MD will discuss the future of chronic pain management by addressing metabolic health and dysfunction. Another important topic in pain management involves the protocols for the use of CBD oil. J. Matthew Andry, MD will talk about appropriate uses of CBD oil for chronic pain.

On behalf of the Board of Directors of ASIPP®, we hope you join us for the largest and most beneficial meeting all year for Interventional Pain Physicians. Don’t miss this VIRTUAL opportunity!

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GENERAL INFORMATION ASIPP ® American Society of ACCREDITATION STATEMENT Interventional Pain Physicians THE VOICE OF INTERVENTIONAL PAIN MANAGEMENT This activity has been planned and implemented in accordance with the accreditation requirements 81 Lakeview Drive, Paducah, KY 42001 and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint Phone: 270.554.9412 | Fax: 270.554-5394 E-Mail: [email protected] providership of The Institute for Medical Studies and The American Society of Interventional Pain Web Site: www.asipp.org Physicians. The Institute for Medical Studies is accredited by the ACCME to provide continuing medical CHAIRMAN OF THE BOARD AND CHIEF EXECUTIVE OFFICER education for physicians. Laxmaiah Manchikanti, MD — Paducah, KY OFFICERS ASIPP® is now an ABA Registered CME Provider PRESIDENT Harold Cordner, MD — Sebastian, FL PRESIDENT-ELECT Amol Soin, MD — Centerville, OH IMMEDIATE PAST PRESIDENT Sudhir Diwan, MD — New York, NY AUDIENCE FIRST EXECUTIVE VICE-PRESIDENT Sheri Albers, DO — Sacramento, CA The courses are intended to present interventional pain management specialists, mid-level providers, VICE-PRESIDENT OF STRATEGIC AFFAIRS Sukdeb Datta, MD — New York, NY staff, and other healthcare providers an in-depth review of multiple areas of interventional pain SECRETARY management. Mahendra R. Sanapati, MD — Evansville, IN TREASURER Sanjay Bakshi, MD — New York, NY LIFETIME DIRECTORS Cyrus E. Bakhit, MD — Roanoke, VA OBJECTIVES Laxmaiah Manchikanti, MD — Paducah, KY Vijay Singh, MD — Niagara, WI ACADEMIC DIRECTORS Discuss and consider established and evolving concepts of interventional pain management in the Salahadin Abdi, MD, PhD — Houston, TX Christopher Gharibo, MD — Franklin Lakes, NJ Covid-19 Era. Jay S. Grider, DO — Lexington, KY Joshua A. Hirsch, MD — Boston, MA YOUNG PHYSICIAN DIRECTORS Helen Blake, MD — Chesterfield, MO OUTCOME Jessica Jameson, MD — Post Falls, ID Kunj Patel, MD — Atlanta, GA Kartic Rajput, MD — Grand Island, NE Participants in the ASIPP® Annual Meeting 2020 will learn to operate comprehensive interventional RESIDENT/FELLOW DIRECTOR Yu Chiu, DO — New York, NY pain care centers more efficiently, so that patients will receive the best care available during and DIRECTORS AT LARGE beyond the Covid-19 Pandemic. They should leave with greater knowledge of interventional pain Steve Aydin, DO — Englewood Cliffs, NJ Ricardo Buenaventura, MD — Centerville, OH management as it applies to their patients and practice. Devi Nampiaparampil, MD — New York, NY Deborah H. Tracy, MD — Brooksville, FL DIRECTORS EMERITUS Ramsin M. Benyamin, MD — Bloomington, IL CATEGORY I CREDIT Frank J.E. Falco, MD — Newark, DE Standiford Helm II, MD — Laguna Hills, CA ABIPP EXECUTIVE DIRECTOR The Institute for Medical Studies designates this live activity for a maximum of 19.75 AMA PRA Category 1 Mark V. Boswell, MD, PhD — Toledo, OH PAIN PHYSICIAN EDITOR-IN-CHIEF Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the Alan D. Kaye, MD, PhD — New Orleans, LA activity. PMCR REPORTS EDITOR-IN-CHIEF Alaa Abd-Elsayed, MD, MPH — Madison, WI AMA HOD Physicians of Osteopathic Medicine — the American Osteopathic Association (AOA) accepts AMA PRA Lee Snook, MD — Sacramento, CA Sunny Jha, MD (alternate) — Los Angeles, CA Category 1 Credits™ as AOA Category 2-B credit. AMA RFS SECTIONAL DELEGATES Alberto Bursian, MD — Gainesville, FL Michael Lubrano, MD — New York, NY AMA RUC RN, NP, AND PA CREDIT Michael Lubrano, MD — New York, NY AMA CPT ADVISORY COMMITTEE Nurse Practitioners: The American Academy of Nurse Practitioners (AANP) accepts AMA PRA Category 1 Credits™ Sunny Jha, MD — Los Angeles, CA STAFF from organizations accredited by the ACCME. Melinda Martin, Director of Operations Karen Avery, Director of Planning Ray Lane, Director of Marketing/Public Relations RNs/ APRNs- most State Nursing Boards accept CE activities designated for AMA PRA Category 1 Credits™ Holly Long, Editorial Services Director towards re-licensure requirements. Check with your board to determine whether they will accept this CME Cindy Rogers, Member Services Summer Woods, State Society Coordinator activity towards your re-licensure. This activity is designated for up to 19.75 AMA PRA Category 1 Credit(s)™ Savannah Gold, Editorial Services Coordinator Caroline Few, Communications Coordinator Vidyasagar Pampati, Statistician and Programmer Physician Assistants- The American Academy of Physician Assistants (AAPA) accepts AMA PRA Category 1 GOVERNMENT AFFAIRS COUNSEL The Honorable Edward Whitfield Credits™ from organizations accredited by the ACCME. Jeff Mortier Farragut Partners LLP 1225 New York Ave. NW, Suite 600 No duplication or distribution of materials, or recording of lectures associated with this conference is permitted without the Washington, DC 20005 express written consent of the American Society of Interventional Pain Physicians. All rights reserved. Membership open to all Interventional Pain Physicians

AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIANS | 3 ASIPP® 2020 ANNUAL MEETING SEPTEMBER 4-6, 2020 | VIRTUAL MEETING

COMPREHENSIVE PHYSICIAN AND PRACTICE REHABILITATION FOR THE SURVIVAL OF IPM ASIPP® 2020 ANNUAL MEETING SCHEDULE COURSE DIRECTORS: LAXMAIAH MANCHIKANTI, MD; SUDHIR DIWAN, MD; HAROLD CORDNER, MD; AMOL SOIN, MD; SHERI ALBERS, DO; DEVI E. NAMPIAPARAMPIL, MD

CONFERENCE ADVISORY COMMITTEE: LAXMAIAH MANCHIKANTI, MD; SUDHIR DIWAN, MD; RICK BUENAVENTURA, MD; HAROLD CORDNER, MD; SHERI ALBERS, DO; BRIAN BRUEL, MD; MILES DAY, MD; MAX ECKMAN, MD; VINCENT GALAN, MD; DAVID GALE, MD; DEVI NAMPIAPARAMPIL, MD; AMOL SOIN, MD

FRIDAY, SEPTEMBER 4, 2020 – (AGENDA BASED ON CENTRAL TIME) 6:00 am – 5:00 pm VIRTUAL HELP DESK - OPEN 7:00 am – 7:50 am BREAKFAST WITH EXHIBITORS 7:50 am – 8:00 am Introduction to Technical Aspects of Webinar 8:00 am – 9:00 am Marketing for Success in the Covid Era 8:00 am –8:10 am Introduction Laxmaiah Manchikanti, MD 8:10 am – 9:00 am Your Advertising and Marketing Playbook in the New Economy Randy Alvarez, The Wellness Hour – Keynote 9:00 am – 10:00 am BREAK WITH EXHIBITORS 10:00 am – 10:45 am SESSION CHAIR | Sudhir Diwan, MD 10:00 am – 10:05 am Welcome and Session Introduction Sudhir Diwan, MD, Past-President, ASIPP® 10:05 am – 10:10 am Women in IPM Helen Blake, MD – President-Elect, Society of Women Innovators in Pain Management 10:10 am – 10:15 am ASIPP and Texas Pain Society Collaboration Brian Bruel, MD, President, Texas Pain Society 10:15 am – 10:25 am Society of Interventional Pain Management Surgery Centers Amol Soin, MD - President, SIPMS 10:25 am – 10:35 am Reflecting on Turbulent Times: Essential to Keep Strong for Survival Sudhir Diwan, MD – Past-President, ASIPP 10:35 am – 10:45 am Looking Forward to the Future: Keeping ASIPP and IPM Strong Harold Cordner, MD - President

10:45 am – 12:00 pm RAJ-RACZ DISTINGUISHED LECTURE SERIES SESSION CHAIR | Aaron Calodney, MD

10:45 am – 10:55 am Introduction to Raj-Racz Distinguished Lecture Series Aaron Calodney, MD 10:55 am – 12:00 pm Survival of IPM During and After Concurrent Epidemics: COVID-19, Opioid, Evidence-Biased Medicine, Reimbursement Cuts, and Onerous Regulations Laxmaiah Manchikanti, MD - Keynote 12:00 pm – 1:00 pm LUNCH – Presentation Sponsored by Medtronic

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1:00 pm – 3:00 pm SESSION CHAIR | Sudhir Diwan, MD

1:00 pm – 1:45 pm Managing Burnout: Moving Forward from Corona Pamela McPherson, MD - Keynote 1:45 pm – 2:30 pm Learning About COVID-19 in IPM Devi Nampiaparampil, MD - Keynote

2:30 pm – 2:45 pm ABIPP Board Certification: More Important Now Than Ever Andrea Trescot, MD 2:45 pm – 3:00 pm The History and Future of ASIPP – Generational Changes Reflecting on IPM with the Concurrent Opioid and Corona Pandemic Sunny Jha, MD and Gabor Racz, MD 3:00 pm – 4:00 pm BREAK WITH EXHIBITORS

4:00 pm – 5:35 pm Billing, Coding, and Compliance SESSION CHAIR | Harold Cordner, MD 4:00 pm – 4:05 pm Session Introduction

4:05 pm – 4:35 pm What is New in Evaluation and Management Services in Store for Us? Judi Blaszczyk, RN, CPC 4:35 pm – 5:05 pm Handling Denials Amy Turner, RN, CPC 5:05 pm – 5:35 pm What is new in Billing and Coding in Store for Us? Judi Blaszczyk, RN, CPC FRIDAY EXHIBIT HALL HOURS 7:00 am – 10:00 am 2:00 pm – 7:00 pm

SATURDAY, SEPTEMBER 5, 2020 – (AGENDA BASED ON CENTRAL TIME)

6:00 am – 5:00 pm VIRTUAL HELP DESK - OPEN 7:00 am – 7:50 am BREAKFAST WITH EXHIBITORS 7:50 am – 8:00 am Introduction to Technical Aspects of Webinar

8:00 am – 9:00 am Learning About the Financial Disruption of COVID-19 SESSION CHAIR | Amol Soin, MD 8:00 am – 8:30 am Insurance Issues: Moving Forward After COVID Epidemic Thomas Wierzbowski and Christina Cassady 8:30 am – 9:00 am Financial Disruption Due to COVID-19: From Reckoning to Rehabilitation Amol Soin, MD - Keynote 9:00 am – 10:00 am BREAK WITH EXHIBITORS

10:00 am – 12:00 pm MANCHIKANTI DISTINGUISHED LECTURE SERIES SESSION CHAIR | Joshua Hirsch, MD

AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIANS | 5 ASIPP® 2020 ANNUAL MEETING SEPTEMBER 4-6, 2020 | VIRTUAL MEETING

SATURDAY, SEPTEMBER 5, 2020 – (AGENDA BASED ON CENTRAL TIME)

MANCHIKANTI DISTINGUISHED LECTURE SERIES – (CONTINUED)

10:00 am – 10:10 am Introduction to Distinguished Lecture Series Joshua Hirsch, MD

10:10 am – 10:25 am Introduction to Dr. Laxmaiah Manchikanti Sheri Albers, DO

10:25 am – 11:10 am Evolving Concepts for Future Health Care Reform, Beyond ACA: It is Corona Pandemic Robert Laszewski – Keynote

11:10 am – 12:00 pm KEYNOTE PANEL DISCUSSION Panel Chair: Joshua Hirsch, MD Panel: Robert Laszewski; Representative Ed Whitfield; Sheri Albers, DO; Laxmaiah Manchikanti, MD; Jeff Mortier; Devi Nampiaparampil, MD; Vanila Singh, MD; Amol Soin, MD

12:00 pm – 1:00 pm LUNCH – Presentation Sponsored by Boston Scientific

1:00 pm – 3:00 pm SESSION CHAIR | Devi Nampiaparampil, MD

1:00 pm – 2:00 pm Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices Kevin Pho, MD – Keynote

2:00 pm – 2:30 pm The Significance of Membership and Contributions Harold Cordner, MD; Hans Hansen, MD; Deborah Tracy, MD

2:30 pm – 3:00 pm Best Practices in Pain Management: Are They Different Now? Vanila Singh, MD - Keynote

3:00 pm – 4:00 pm BREAK WITH EXHIBITORS

4:00 pm – 5:30 pm ABSTRACT SESSION Co-Chairs: Miles Day, MD; Shalini Shah, MD; Sal Abdi, MD, PhD Committee: Alan Kaye, MD, PhD; Sudhir Diwan, MD; Chris Gharibo, MD; Rinoo Shah, MD

SATURDAY EXHIBIT HALL HOURS: 7:00 am – 10:00 am 2:00 pm – 7:00 pm

SUNDAY, SEPTEMBER 6, 2020 – (AGENDA BASED ON CENTRAL TIME) 6:00 am – 5:00 pm VIRTUAL HELP DESK - OPEN

7:00 am – 7:50 am BREAKFAST WITH EXHIBITORS 7:50 am – 8:00 am Introduction to Technical Aspects of Webinar

8:00 am – 10:15 am The Future of Chronic Pain Management –Metabolic Health, Insulin Resistance, and Hormonal Imbalance

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8:00 am – 10:15 am SESSION CHAIR | Laxmaiah Manchikanti, MD

8:00 am – 8:05 am Introduction - Laxmaiah Manchikanti, MD

8:05 am – 8:45 am Managing Inflammation, Insulin Resistance, and Hormonal Imbalance in Chronic Pain Matt Andry, MD – Keynote

8:45 am – 9:30 am Evidence-based Medicine of Preventive Cardiology: Facts and Fiction Brett Scher, MD – Keynote

9:30 am – 10:15 am The Future of Chronic Pain Management: Addressing Metabolic Health and Dysfunction Gurpreet Padda, MD - Keynote

10:15 am – 11:15 am BREAK WITH EXHIBITORS

11:15 am – 12:00 pm SESSION CHAIR | Amol Soin, MD

11:15 am – 11:30 am Establishing a Valid Protocol for Corona Testing in Your Practice Devi Nampiaparampil, MD

11:30 am – 11:45 am Selection Criteria for IPM Techniques During and After Corona Pandemic: How and Why? Shalini Shah, MD

11:45 am – 12:00 pm DISCUSSION PANEL Chair: Amol Soin, MD Panel: Ricardo Buenaventura, MD; Devi Nampiaparampil, MD; Shalini Shah, MD

12:00 pm – 1:00 pm LUNCH – Presentation Sponsored by Fedora Solutions

1:00 pm – 3:00 pm SESSION CHAIR | Amol Soin, MD

1:00 pm – 1:40 pm Strategies and Considerations for the COVID Era: Trainees and Employment Shalini Shah, MD - Keynote

1:40 pm – 2:20 pm Antithrombotic Guidelines Tammy Dann, MD

2:20 pm – 3:00 pm Antiaging of the Brain and Resetting the Grim Reaper’s Clock Sheldon Jordan, MD - Keynote

3:00 pm – 4:00 pm BREAK WITH EXHIBITORS

4:00 pm – 5:30 pm SESSION CHAIR | Hans Hansen, MD

4:00 pm – 4:05 pm Session Introduction

4:05 pm – 5:00 pm Pathophysiology of Controlled Substance Use, Overuse, Abuse, Dependency, and Addiction Susan Blank, MD – Keynote

5:00 pm – 5:30 pm Developing and Incorporating Regenerative Medicine Annu Navani, MD

SUNDAY EXHIBIT HALL HOURS: 7:00 am – 11:30 am 4:00 pm – 6:00 pm

AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIANS | 7 ASIPP® 2020 ANNUAL MEETING SEPTEMBER 4-6, 2020 | VIRTUAL MEETING

ASIPP® 2020 ANNUAL MEETING

Registration PLEASE PRINT EXACTLY AS YOU WISH YOUR NAME TO APPEAR: Form

PAYMENT METHOD REGISTRATION FEES CREDIT CARD 22ND ANNUAL MEETING (CHECK THE FEE THAT APPLIES): m MasterCard m VISA DISCOUNT ON OR AFTER m American Express m Discover m Check BEFORE AUGUST 5 AUGUST 5 m ASIPP Active Member ...... $ 1,000 $ 1,100

______m Associate Member ...... $ 500 $ 600 CREDIT CARD NUMBER (Non-Interventional Physician; Nurse Practitioner, or Physician Assistant member) m Associate Non-member ...... $ 600 $ 650 m Non-Member Physician ...... $ 1,200 $ 1,300 ______CARDHOLDER NAME m Affiliate Member (RN, Staff) ...... $ 300 $ 400 m Affiliate Non- Member ...... $ 500 $ 600 m Military Member ...... $ 100 $ 200 ______EXPIRATION DATE SECURITY CODE m Military Non-member ...... $ 200 $ 300 DISCOUNT EXTENDED TO SEPT 4 m Fellow/Resident ...... $ 50 $ 100 ______m Medical Student ...... $ 10 $ 50 CHECK NUMBER

MAIL COMPLETED FORM WITH CHECK TOTAL REGISTRATION FEES: $ ______OR PAYMENT INFORMATION TO: ASIPP®, 81 Lakeview Drive, Paducah, KY 42001 If registering as a fellow, resident or medical student, please list name of fellowship program, university or hospital. Discount cannot be given without this information. FAX COMPLETED FORM WITH PAYMENT INFORMATION TO: (270) 554-5394 ______CANCELLATION POLICY: NAME OF SCHOOL OR HOSPITAL The American Society of Interventional Pain Physicians requires a 30-day notice of REGISTRANT INFORMATION cancellation. Cancellations must be submit- ted in writing and received by August 5, 2020; ______however an administrative fee of $100 will be FIRST NAME LAST NAME CREDENTIALS assessed. Cancellations after August 5, 2020, will forfeit 50% of their registration fee. No ______cancellations made after August 19, 2020, will ORGANIZATION be refunded. Refunds will be sent after the conclusion of ______ADDRESS the meeting. Organizers reserve the right to cancel this meeting and will assume no ______financial obligation to the registrants for CITY STATE ZIP COUNTRY cancellation. Although registration fees will be refunded, costs incurred by the registrant ______(i.e., airline fees, hotel fees, or penalties) are PHONE CELL FAX the responsibility of registrant. ______EMAIL VIRTUAL Registration fee includes all sessions, breakfasts, lunches, coffee breaks, and electronic materials for the conference. HELP DESK Or register online at https://www.prereg.net/2020/asipp/ ASIPP® will assist beginning at AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIANS 6:00am each day. Login credentials will be THE VOICE OF INTERVENTIONAL PAIN MANAGEMENT supplied prior to start of the meeting. 81 LAKEVIEW DRIVE. PADUCAH, KENTUCKY 42001 PHONE: 270-554-9412 | FAX: 270-554-5394 | WEB: WWW.ASIPP.ORG | EMAIL: [email protected]

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