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| * First Name |
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| **Middle Initial |
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| * Last Name |
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| * Professional Degree |
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| * Address |
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| * City |
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| * State |
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| * Country |
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| * Zip |
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| * Phone |
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| * Fax |
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| * E-Mail |
(If you do not have an email please type in "None@thistime.com" ). |
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* Please Register Me for:
(Check all courses you wish to be enrolled in and then choose location) |
Injectables Module: |
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Cosmetic Use of Botulinum Toxin A (BOTOX® Cosmetic)
Use of Facial Fillers for Aesthetic Enhancement
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| Please Select Location: |
Columbus, Ohio |
Seattle, Washington |
Sarasota, Florida |
January 19-20, 2008
June 7-8, 2008
October 18-19, 2008
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February 16-17, 2008
June 28-29, 2008
November 1-2, 2008 |
May 17-18, 2008
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2-
Day Course Fee = $4500 |
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Aesthetic Lasers and Light Module: |
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| Please Select Location: |
Columbus, Ohio |
Seattle, Washington |
Sarasota, Florida |
January 21-22, 2008
June 9-10, 2008
October 20-21, 2008
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February 18-19, 2008
June 30-July 1, 2008
November 3-4, 2008 |
May 19-20, 2008
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2-
Day Course Fee = $1500 |
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Aesthetic Treatment Module: |
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Sclerotherapy
Body Contouring
Chemical Peels
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3-
Day Course Fee = $2500 |
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Advanced Facial Filler Course: |
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1-
Day Course Fee = $2500 |
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| Registration Fees: |
Injectables Modules |
Aesthetic Lasers and Light Module |
Aesthetic Treatment Module |
2-day Courses =$4500 |
2-day Courses = $1500 |
3-day Courses = $2500 |
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| (Payments terms: 50% due with registration. Balance due 14 days prior to training.) |
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Please provide the information below: |
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| * Credit Card Type: |
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| * Credit Card Number: |
example: ( 1234567890123456 ) |
| * Expiration Date: |
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| * Enter Card Name: |
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| * Card Security Code: |
What is this? |
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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:
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