2021 The 72th Korean pain Society

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Online registration

1. Participant Information

*Country
Members of society	* Members of Japan Society of Pain Clinicians and Chinese Association for the Study of Pain signed MOU with KPS receive 50% registration fee discount only for pre-registration period. Japan Society of Pain Clinicians Pain Physician Branch of Chinese Medical Doctor Association
*Department	Dept. of Anesthesiology and Pain Medicine Except Dept. of Anesthesiology and Pain Medicine
*Category II	Regular Resident Army Doctor Public Health Doctor Research worker Medical Student Nurse
*Name	First* Middle Last *
*Title	Mr. Ms. Prof. Dr. Others
*Department		*Position
*Organization
*Address	Zip Code
*Tel		*Mobile
*E-mail
*Special Request	Vegetarian Muslim Kosher None Others
*Password	(*You need to modify the pre-registration.)

* Items marked with asterisk (*) must be completed.

2. Registration Fee

Date	Scientific Meeting (20^th. Nov) Training Conference (21^th. Nov)
Workshop (16^th. Nov)	Workshop I (Basic C-arm Techniques) Workshop II (Vertebral Augmentation) Workshop III (Epiduroscopy) Workshop IV (Image Workshop (Spine))
Workshop (17^th. Nov)	Workshop V (US Examination (Upper Extemity)) Workshop VI (US Examination (Lower Extemity)) Workshop Ⅶ (ESWT)
Gala Dinner	Attend Not Attend

3. Total amount

Scientific Meeting	USD	Training Conference	USD
Workshop I	USD	Workshop V	USD
Workshop II	USD	Workshop VI	USD
Workshop III	USD	Workshop Ⅶ	USD
Workshop IV	USD	Gala Dinner	USD
Total amount	USD

>4. Payment Method (Bank Transfer Only)

Bank Name	Shinhan Bank	Account Number	140-012-267339
Swift Code	SHBKKRSE	Account Holder	Korean Pain Society
Payment Date		Name of Remitter