2026 USASP Meeting

The USASP is excited to have people with lived experience with pain participate in our activities, particularly our annual scientific meeting.

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* 1. Full Name:

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* 2. Email:

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* 3. Phone Number:

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* 4. Membership Status (Membership is a requirement for funding eligibility):

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* 5. Role in the Annual Meeting:

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* 6. Are you requesting funding for any of the following? (Check all the apply)

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* 7. Estimated Budget Requesting (Please itemize your request. For example: Registration - $400, Travel
- $500, etc.):

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* 8. Amount Requested from USASP:

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* 9. Do you have alternative funding sources?
(If yes, please list them. If no, please explain your financial need for this funding. Limit to 200 words.)

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* 10. What are your goals for attending the USASP Annual Meeting? (Explain how attending the meeting aligns with your goals and supports USASP's mission. Limit to 300 words.)

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* 11. Do you have any other comments or information to
share?

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* 12. I declare that the information provided in this form is accurate and truthful.

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* 13. Signature:

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* 14. Date:

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