The Ageless Aesthetic Institute
Course Registration Form



* Required  
   
* First Name
**Middle Initial
* Last Name
* Professional Degree
   
* Address
* City
* State
* Country
* Zip
* Phone
* Fax
* E-Mail
(If you do not have an email please type in "None@thistime.com" ).
   

* Please Register Me for:
(Check all courses you wish to be enrolled in and then choose location)
Injectables Module:


Cosmetic Use of Botulinum Toxin A (BOTOX® Cosmetic)

Use of Facial Fillers for Aesthetic Enhancement

 

 
Please Select Location:
Columbus, Ohio
Seattle, Washington
Sarasota, Florida
January 19-20, 2008
June 7-8, 2008
October 18-19, 2008
February 16-17, 2008
June 28-29, 2008
November 1-2, 2008
May 17-18, 2008
 
2- Day Course Fee = $4500
 

 
Aesthetic Lasers and Light Module:
 
Please Select Location:
Columbus, Ohio
Seattle, Washington
Sarasota, Florida
January 21-22, 2008
June 9-10, 2008
October 20-21, 2008
February 18-19, 2008
June 30-July 1, 2008
November 3-4, 2008
May 19-20, 2008
 
2- Day Course Fee = $1500
 

 
Aesthetic Treatment Module:
 

Sclerotherapy
Body Contouring
Chemical Peels

   
Columbus, Ohio
March 9-11, 2008
September 13-15, 2008
   
3- Day Course Fee = $2500
 

 
Advanced Facial Filler Course:
 
Columbus, Ohio
March 8, 2008
 
1- Day Course Fee = $2500

Registration Fees:
Injectables Modules
Aesthetic Lasers and Light Module
Aesthetic Treatment Module
2-day Courses =$4500
2-day Courses = $1500
3-day Courses = $2500
(Payments terms: 50% due with registration. Balance due 14 days prior to training.)
   
Please provide the information below:
   
* Credit Card Type:
* Credit Card Number: example: ( 1234567890123456 )
* Expiration Date:
* Enter Card Name:
* Card Security Code:    
What is this?
 

Confirmation: A confirmation e-mail will be sent to you as confirmation of your registration. Syllabus materials pertaining to the registered courses will be sent 30 days prior to the training date.

Refunds: Refunds will be given (less a $250.00 non-refundable processing fee) until 30 days prior to the seminar. After 30 days, no refund will be issued. Tuition may be transferred to future courses for an additional $250.00 processing fee.

Referred By:

 
    






to top
 

800.420.2689
614.579.5530

P.O. Box 20642
Columbus, Ohio
43220
 
Home  |  Contact Us  |  Accreditation  |  Privacy Policy  |  Dr. McQuillan  |  Consulting Services  |  Skin Care
Course Information  |  Events  |  Terms of Use
 

Copyright © 2005 The Ageless Aesthetic Institute & MedNet Technologies, Inc. All Rights Reserved
MedNet-Sites™ - Powered by MedNet Technologies, Inc

 
MedNet-Sites by MedNet Technologies