ASIPP : : : American Society Of Interventional Pain Physicians

" The Voice Of Interventional Pain Management "

ONLINE DUES FORM

American Society of Interventional Pain Physicians

Dues Form

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ASIPP Renewal Dues

$	ASIPP Active Member - (Choose 1 below and type its'value In box)
	$450 Physicians
	$150 Military physicians
	$100 Fellows and residents
	$25 Medical students
	$150 International Member (associate status)
	$150 ASIPP Associate Member Dues
$ Contributions to ASIPP
State Dues (State dues will be forwarded to your state society)
$ State Active Member Dues $150.00
$ State Associate Member Dues $75.00
$ Contributions to State Society
(Except in those states that bill for state society dues directly which include: FL, NJ, MN, TX, CT. You may see State Society information by clicking here.)

ASIPP 2007 Past Dues

$	ASIPP 2007 Past Due Amount - (Past dues must be paid to renew. Select one if applicable and type it's value in box)
	$350 Physicians
	$150 Military physicians
	$100 Fellows and residents
	$25 Medical students
	$100 International Member (associate status)
	$100 ASIPP Associate Member Dues

State 2007 Past Dues (State dues will be forwarded to your state society)

$ State Active Member Dues $100.00

$ State Associate Member Dues $50.00

Total Payment: $

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