Onsite Meeting Registration Form

When, What, Where
Haven’t registered yet? Already registered but want to add sessions? Bring this form fully completed to the ASRA registration desk located in the Forum Ballroom Foyer at Caesars Palace Hotel along with payment (credit card or check only).
Wednesday: 4:00-6:00 pm - Early Registration
Thursday: 7:00 am -7:30 pm
Friday: 7:30 am -5:30 pm
Saturday: 7:30 am -5:30 pm
Questions: / Contact ASRA at 412.471.2718, or visit the registration desk onsite.
Attendee Information
*Will appear on badge exactly as written.
If already pre-registered and adding sessions, please indicate your name, telephone, and email only.
First name*: / Last name*: / Degree(s) (MD, DO, PhD, etc.)*:
Professional title*: / Organization/institution/company*:
Street address:
City*: / State/province*: / Zip/postal code: / Country:
Telephone: / Cell: / Email:
Emergency contact (optional): / Telephone: / Email:
Special physical or dietary needs (optional; accommodated in compliance with the Americans with Disabilities Act)
Meeting Registration
Main meeting registration includes: refresher courses • parallel sessions • ePosters and moderated sessions • exhibit hall access with company booths, ASRA chat room, and internet café • daily breakfast and breaks • opening networking reception • reduced pricing to the 40th anniversary celebration and ASRA awards luncheon • meeting materials and presentations • workshops and PBLDs not included
* Proof of status required at meeting registration desk to obtain badge and materials. / Onsite
from May 6, 2015
Main Meeting
Physician Member of ASRA, ESRA, LASRA, AOSRA* / $885
Physician Non-Member / $1,165
Trainee Member* / $290
Trainee Non-Member* / $335
Nurse Practitioner, Physician Assistant / $575
Active-Duty Military ASRA Member* / $370
Other (not listed above) / $575
Day Rate / $575
Exhibitor (complimentary with booth, limited number) / $0
Additional Exhibitor Badge / $195
Special Events
Guest Ticket Networking Reception (Thurs.; free to attendees) / $60
Excellence in ASRA Awards Luncheon (Sat.) / $25
40th Anniversary Celebration (Sat.. pm) (tickets on sale until Saturday noon)
Attendee / $80
Trainee / $60
Guest Ticket / $80
Exhibitor/Industry / $200
Tailor Your Education with Specialized Sessions
Space is limited, register early.
Only available sessions are listed below. Please note that ASRA doesn’t guarantee availability onsite as sessions are actively filling. See the registration desk for information. / Onsite
from May 6, 2015
Resident/Fellow Program (Sat.)
Resident/Fellow Educational Sessions / $70
Problem-Based Learning Discussions
PBLD (Thurs., lunch included; select one) / $90
PBLD1 How to Use a Clinical Registry to Target Areas for Quality Improvement and Enhanced Patient Safety
PBLD2 Clinical Strategies for Optimizing Regional Anesthesia in the Morbidly Obese
PBLD3 Ambulatory Breast Surgery: What Is the Role of the Paravertebral Block?
PBLD4 Whom Should I Not Block: Absolute and Relative Contradictions to Peripheral Regional Anesthesia?
PBLD5 I Have a 13 Year Old for a Bankart Repair; Can I Do an Interscalene Block Asleep?
PBLD6 Thoracic Paravertebral Blocks vs. Epidural for Thoracotomy
PBLD7 Tranexamic Acid: My Surgeon Likes It, But Are There Contraindications?
PBLD8 Educating the Next Generation of Regional Anesthesiologists
PBLD10 Should I Worry About Falls in Patients with Lower Extremity Peripheral Blocks?
PBLD11 Regional Anesthesia in the Trauma Patient
PBLD12 Pediatric Blocks Every Anesthesiologist Should be Familiar With
PBLD14 Regional Anesthesia in Patients with Neurologic Disease
PBLD17 Clinical Alternatives to Epidural Analgesia in the Pain Management After Thoracic or Abdominal Surgery
PBLD18 TAP and Rectus Sheath Blocks: When and Why?
PBLD19 Optimizing Perioperative Multimodal Analgesia
PBLD21 Ultrasound vs. Nerve Stimulation for Continuous Blocks
PBLD23 Is the Beach Chair a Safe Position for My Patients?
PBLD24 Statistics Every Anesthesiologist Needs to Know
PBLD25 The Best Anesthetic to Optimize Cancer Survival After Mastectomy
Workshops (Physicians only)
Onsite
from May 6, 2015
Ask the Experts Interactive Demonstration Workshops
WS-1 / Pediatric: Upper and Lower Extremity and Caudals / Thurs, May 14 / 8:00-9:30 AM / $145
WS-2 / Blocks for the Airway / Thurs, May 14 / 8:00-9:30 AM / $145
WS-3 / Nerve Block Complication Diagnosis with US / Thurs, May 14 / 8:00-9:30 AM / $145
WS-6 / Pediatric: Paravertebral, Lumbar Plexus, and TAP / Thurs, May 14 / 10:00-11:30 AM / $145
WS-7 / Blocks for the Arm, Elbow, and Hand / Thurs, May 14 / 10:00-11:30 AM / $145
WS-8 / Blocks for Knee and Ankle Surgery / Thurs, May 14 / 10:00-11:30 AM / $145
WS-13 / Blocks for Shoulder Surgery and Awake CEA / Thurs, May 14 / 2:45-4:15 PM / $145
WS-14 / Lumbar Plexus Blocks and Proximal Sciatic Approaches / Thurs, May 14 / 2:45-4:15 PM / $145
WS-16 / Dual-Guidance Brachial Plexus Blocks / Thurs, May 14 / 4:30-6:00 PM / $145
WS-17 / Dual-Guidance Lower Extremity Blocks / Thurs, May 14 / 4:30-6:00 PM / $145
WS-18 / Blocks for Shoulder Surgery and Awake CEA / Fri, May 15 / 8:00-9:30 AM / $145
WS-19 / Blocks for Knee and Ankle Surgery / Fri, May 15 / 8:00-9:30 AM / $145
WS-24 / Neuraxial: Thoracic Epidural and Lumbar CSE / Fri, May 15 / 1:30-3:00 PM / $145
Hands-On Workshops
WS-4 / Challenging Anatomy / Thurs., May 14 / 8:00-10:00 AM / $180
WS-9 / Lower Extremity / Thurs., May 14 / 10:15 AM-12:15 PM / $180
WS-10 / Upper Extremity / Thurs., May 14 / 1:45-3:45 PM / $180
WS-20 / Challenging Anatomy / Fri, May 15 / 8:00-10:00 AM / $180
WS-26 / CPNB for the Chest and Abdomen / Fri, May 15 / 1:30-3:30 PM / $180
Comprehensive Workshops (half-day)
WS-5 / Upper Extremity and Challenging Anatomy / Thurs., May 14 / 8:00 AM-12:15 PM / $360
WS-11 / Lower Extremity and Challenging Anatomy / Thurs., May 14 / 1:45-6:00 PM / $360
WS-21 / Dual-Guidance Blocks for Lower and Upper Extremity Joints / Fri, May 15 / 8:00 AM-12:00 PM / $360
Simulation Workshops (half-day)
WS-30 / Crisis Management for the Regional Anesthesiologist / Sat, May 16 / 8:00-11:45 AM / $360
WS-32 / Crisis Management for the Regional Anesthesiologist / Sat, May 16 / 2:00-5:30 PM / $360
Total amount due: / $
Payment
Check: payable to the American Society of Regional Anesthesia and Pain Medicine (US dollars only).
Credit Card: / Visa / MasterCard / American Express / Discover
Name on card: / Credit card number: / Expiration date: / Security code:
Billing address (if different from above): / Electronic signature:
Attendee List
ASRA provides an attendee list containing name, degree, title, organization, and physical mailing address to industry partners and fellow attendees. Email and telephone are not provided. Click here to remove your name from the list.
Attendance Policies
Submission of registration acknowledges compliance with all attendance policies.
Attendee cancellation and refunds: Registration fees are refundable, minus a $100 processing fee, if cancellation is received in writing no later than three (3) weeks prior to the event commencement. After this date, under no circumstances will refunds or credits be granted.
Attendee substitutions: Attendee substitutions are allowed if notification is made in writing no later than three (3) weeks prior to the event commencement. A $100 processing fee will be charged. After this date, under no circumstances will substitutions be granted.
Attendee no-shows: No refunds or credits will be given to “no shows.”
Attendee guests/accompanying persons: All event activities(including educational sessions, meal functions, exhibit hall, etc.) are exclusively reserved for registered attendees.Non-registered guests (including children, family members, colleagues,etc.) are not allowed in the event areas. Badges provided at registration are required for entrance into all functions and will be strictly enforced. Guests may be invited to attend social events or meal functions that are clearly separated from the CME portions of the activity. In which case, a separate fee will be charged to cover guest participation and a ticket issued. See event registration fees for details.
Photography and recording privileges: ASRA reserves exclusive rights to photograph and/or record (audio and video) all event proceedings and participants for use in marketing materials, presentations, and course content reproductions (online or other). Photography and/or recording by individuals is not permitted in the scientific, educational, and business meetings during any ASRA event, unless specifically pre-authorized by ASRA. Individuals granted such privileges shall be properly registered at the event and issued the proper proof of privileges (press badge or other).
ASRA modification or cancellation: ASRA reserves the right to modify the event’s schedule or program, as necessary. ASRA also reserves the right to cancel this event, in which case a full refund of the registration fee will be provided. ASRA is unable to refund any attendee expenses (flight, hotel, etc.) in the case of ASRA cancellation.

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