American Society of Interventional Pain PhysiciansThe Voice of Interventional Pain Management since 1998

Cadaver Workshop And online video lectures (BAsic, intermediAte, And comprehensive interventionAl pAin mAnAgement exAminAtion prepArAtion course)oCtober 5-6, 2013 | denver, Colorado Up to 14.75 aMa pra Category 1 Credits™ for Workshop and Up to 7 aMa pra Category 1 Credits™ for video leCtUres

PRSRT STDU.S. PoSTage

PaidPaDUcah, KY

PeRmiT #44

American Society of Interventional Pain Physicians81 Lakeview Drive, Paducah, KY 42001

host hotel:the Westin

denver doWntoWn1672 laWrenCe street

denver, Co 80202(303) 572-9100

Cadaver Workshop:sCienCe Care

19301 east 23rd avenUeaUrora, Co 80011tel: 800-417-3747

speCials:• Special room rateS through

septeMber 12, 2013• 50% off meeting fee to

felloWs & residents• $100 for interventional teCh-

niqUes in ChroniC spinal pain and ChroniC non-spinal pain

at Meeting• 10% off foundationS, clinical

aspeCts, and/or board revieW self-assessMent books• 20% off eSSentialS of praCtiCe ManageMent

Cadaver WorkshopAnd online video lectures (BAsic, intermediAte, And comprehensive interventionAl pAin mAnAgement exAminAtion prepArAtion course)Up to 14.75 aMa pra Category 1 Credits™ for Workshop and Up to 7 aMa pra Category 1 Credits™ for video leCtUres

oCtober 5-6, 2013 | denver, Colorado host hotel:the Westin denver downtown, 1672 lawrence street, denver, co 80202. (303) 572-9100

Cadaver Workshop:science care, 19301 east 23rd Avenue, Aurora, co 80011. (800) 417-3747

speCials:• Special room rates through September 12, 2013• 50% Off Meeting Fee to Fellows & Residents• $100 for Interventional Techniques in Chronic Spinal Pain and Chronic Non-Spinal Pain at Meeting

ASIPP® EducAtIonAl SErvIcES | ExcEllEncE In EducAtIon of IntErvEntIonAl PAIn PhySIcIAnS

AmericAn Society of interventionAl PAin PhySiciAnS

Cadaver Workshop and online video leCtUres | BAsic, intermediAte, And ABipp prepArAtionoCtober 5-6, 2013 | denver, Colorado

desCription, pUrpose and target aUdienCeThis 1½-day workshop is designed for interventional pain physicians, for a review, skills improvement, or to assist in preparation for Comprehensive Interventional Pain Management Examination qualifications. ASIPP offers the most in-depth, comprehensive, and individualized programs available in interventional pain management, featuring maximum hands-on training with cadavers in a state-of-the-art facility and maximum ability to interact with other participants. Participants will experience a comprehensive and intense learning opportunity, focusing on interventional pain management techniques.

• Each cadaver station is limited to a maximum of 7 participants.• Participants can choose the level of participation: basic, intermediate, or

Comprehensive Interventional Pain Management Examination Preparation course.

• C-arms and state-of-the-art equipment are utilized in this course. Participants are requested to dress in casual attire or scrubs. Leaded aprons and thyroid shields will be provided. However, participants are advised to bring their own protective eyewear.

• Participants will be provided with 7 video lectures relevant to the course material

The workshop is offered to improve the delivery of multiple aspects of interventional pain management. The desired outcome is to integrate multiple aspects of interventional pain management in treating your patients so that patients have better outcomes and reduced side effects.

oUtCoMePhysicians should be able to integrate multiple aspects of interventional pain management techniques in patient treatments so that patients have better outcomes and reduced side effects.

THERE IS NO COMMERCIAL SuPPORT FOR THIS COuRSE. NO duPLICATION OR dISTRIbuTION OF MATERIALS, OR RECORdINg OF LECTuRES ASSOCIATEd. THERE IS NO COMMERCIAL SuPPORT FOR THIS COuRSE.

Cadaver lab CoUrse levelsbasiC interMediate CoMprehensive ipM exaMination

preparation - advanCed

1. Caudal epidural injections

2. Lumbar interlaminar epidural injections

3. Lumbar transforaminal epidural injections

4. Sacroiliac joint interventions

5. Lumbar facet joint nerve blocks

6. Thoracic facet joint nerve blocks

7. Cervical facet joint nerve blocks

8. Lumbar facet radiofrequency neurotomy

1. Lumbar discography

2. Percutaneous adhesiolysis

3. Lumbar sympathetic blocks and hypogastric plexusblocks

4. Lumbar facet joint nerve blocks and radiofrequency neurotomy

5. Cervical and thoracic interlaminar epidurals

6. Thoracic facet interventions (medial branch blocks, and radiofrequency neurotomy)

7. Cervical facet joint interventions (medial branch blocks, and radiofrequency neurotomy)

8. Celiac plexus block

1. Caudal, lumbar, thoracic, cervical interlaminar epidural

2. Lumbar transforaminal and discography

3. Lumbar facet joint interventions (facet joint nerve blocks, and radiofrequency neurotomy)

4. Thoracic facet joint interventions (medial branch blocks and radiofrequency neurotomy), intercostal nerve blocks

5. Cervical facet joint interventions (medial branch blocks and radiofrequency neurotomy) and cervical interlaminar epidural injections

6. Spinal cord stimulation lead placement

7. Sympathetic blockade (stellate ganglion, lumbar sympathetic blocks and celiac plexus blocks)

8. Sacroiliac injections joint injections and adhesiolysis

aCCreditation and CMe Credit stateMentsThis live and online CME activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education thru the Joint Sponsorship of the Institute for Medical Studies (IMS) and ASIPP. IMS is accredited by the ACCME to provide continuing medical education for physicians.

The Institute for Medical Studies designates this educational activity for a maximum of 21.75 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

aMeriCans With disabilities aCt & speCial serviCesOrganizers fully comply with the legal requirements of the Americans with disabilities Act and the rules and regulations thereof. If any participant in these educational activities is in need of accommodations, please contact the organizers at (270) 554-9412 at least 10 days prior to each conference.

Cadaver Workshop sitescience care sets the standard of excellence for the donation and responsible use of human tissue for medical research, training and professional education. science care is the only organization to be accredited by both the American Association of Tissue banks (AATb) and accredited as a provider by the Accreditation Council for Continuing Medical Education (ACCME).

AmericAn Society of interventionAl PAin PhySiciAnS

Cadaver Workshop and online video leCtUres | BAsic, intermediAte, And ABipp prepArAtionoCtober 5-6, 2013 | denver, Colorado

accommodationsthe Westin denver doWntoWn1672 LaWrence streetdenver, co 80202(303) 572-9100

Located in renowned Lower Downtown Denver, we’re a stroll away from the 16th Street pedestrian mall, Denver center for Performing arts, convention center, museums, and entertainment. We’re also within walking distance of professional sports venues. inform the hotel that you are booking for asiPP. We have secured a group room rate of $169. reserve rooms early—all unbooked rooms will be released on september 12, 2013.

6:30am shuttLes dePart from host hoteL to the cadaver faciLity

7:00am–7:30am registration and Breakfast

7:30am–8:00am introduction to Workshop - Laxmaiah manchikanti, md

Basic and intermediate iPm PreParation

8:00am–9:00am imaging for interventionalists – fluoroscopy, radiation safety, and needle Placement - david schultz case discussions - Lumbar and cervical

9:15am–1:00pm hands-on cadaver WorkshoPParticipants rotate through multiple stations

1:00pm–2:30pm Working Lunch - discussion of video Lectures - Problem focused discussion Working Lunchcase discussions - Lumbar and cervical

2:30pm–6:15pm hands-on cadaver WorkshoPParticipants rotate through multiple stations

6:15pm shuttLes dePart from cadaver faciLity to the host hoteL

hanDS-on caDaveR WoRKShoPsaturday ocTobeR 5, 2013

hanDS-on caDaveR WoRKShoPsunday ocTobeR 6, 2013

6:30am shuttLes dePart from host hoteL to the cadaver faciLity

6:45am–8:00am registration, Breakfast, and morning Lecture:

Bleeding and infection control in interventional Pain management - Laxmaiah manchikanti, md

Basic and intermediate iPm PreParation

8:00am–8:30am discussion of video Lectures - Problem focused discussion case discussions - Lumbar and cervical

8:45am–11:15am hands-on cadaver WorkshoP

11:15am adjournment With shuttLes deParting from cadaver faciLity to airPort and host hoteL

comPRehenSive RevieW coURSenote: The onLine RevieW coURSe viDeoS mUST be vieWeD PRioR To aTTenDing The hanDS-on caDaveR WoRKShoP

registration form

registration information

Please complete the enclosed registration form and

return to aSiPP with payment (your application will

not be processed if payment does not accompany

registration form).

ASIPP reserves the right to cancel this Workshop upon

reasonable notice and will assume no financial obligation

to registrants for cancellation of the course for reasons

beyond its control. Registration fees will be refunded.

However, costs incurred by the registrants, such as airline

or hotel fees or penalties, are the responsibility of the

registrants.

registrants who are not accepted into this

workshop will receive notice by mail with their

returned check.

PLease Print exactLy as you Wish your name to aPPear:

_____________________________________________________________________________________________________name (FiRST) (miDDLe iniTiaL) (LaST) (DegRee)

_____________________________________________________________________________________________________oRganizaTion

_____________________________________________________________________________________________________aDDReSS

_____________________________________________________________________________________________________ciTY STaTe ziP

_____________________________________________________________________________________________________Phone Fax

_____________________________________________________________________________________________________e-maiL

comPrehensive revieW course and cadaver WorkshoP

registration fees: m $2,500 member m $2,800 non-memberfellows: m 50% Discount***

***If registering as a fellow, please list below the name of fellowship program, university or hospital and fax or e-mail a letter from the program director verifying your status. Your application for registration cannot be processed and you will not receive the 50% discount until ASIPP receives this letter. Fax the letter to 270-554-5394 or e-mail to crogers@asipp.org

_____________________________________________________________________________________________________name oF FeLLoWShiP PRogRam

Payment method (Please check one):m maSTeRcaRD m viSa m ameRican exPReSS m DiScoveR

______________________________________________________________________________________________cReDiT caRD nUmbeR SecURiTY coDe (Back of Card)

______________________________________________________________________________________________exP. DaTe

______________________________________________________________________________________________name on caRD

______________________________________________________________________________________________aUThoRizeD SignaTURe (required on all credit card orders)

(Your application will not be processed if payment does not accompany registration form)

return comPLeted form to:asiPP, 81 Lakeview Drive, Paducah, KY 42001 or Fax to (270) 554-5394

canceLLation PoLicy: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. Registration fees will be refunded however, costs incurred by the registrants, such as airline or hotel fees or penalties, are the responsibility of the registrants. aSiPP requires a 30-day notice of cancellation. cancellations must be submitted in writing by September 4, 2013. an administrative fee of $200 will be assessed. cancellations after September 4, 2013 but prior to September 25, 2013, will forfeit 50% of their registration fee. no cancellations accepted after September 25, 2013. Refunds will be sent after the conclusion of the meeting.

imPortant. Please answer all the questions:

medicaL degree:m mD m Do

m additional: _______________________________

Primary sPeciaLty certification:m anesthesiology m Physiatry

m neurosurgery

m other: _______________________________

Pain medicine suBsPeciaLty certification:m american board of anesthesiology

m american board of Pain medicine

m american board of interventional Pain Physicians

m Fellow of interventional Pain Practice (FiPP)

sPeciaLty designation:m 09 - interventional Pain management

m 72 - Pain management

m other: ______________________________________

Percentage of interventionaL Pain management Practice:m 0% m 1-25% m 26-50% m 51-75% m > 75%

years in interventionaL Pain management Practice:m 0 m 1-5 m 6-10 m > 10

course LeveL:m basic m intermediate

m iPm examination Preparation

Cadaver Workshop and online video leCtUres | BAsic, intermediAte, And ABipp prepArAtionoCtober 5-6, 2013 | denver, Colorado