Registration form

Intro to Botox / Dysport / Dermal Filler Course

Fill out the form below to register for the Intro to Botox/Dysport/Dermal Filler Course. Once our office reviews your registration form, we will contact you for payment. After 50% non-refundable payment has been received, we will mail your course material. The remaining 50% will be required before your practicum is booked.

Intro to Botox/Dysport/Dermal Filler Course

Name

First

Last

Phone #

Mailing Address for Course Material

City

Province

Postal Code

How did you hear about us?

What is your current profession?

Are you practicing injections currently? If yes, where?

Course Cost

I understand that the cost of this course is $6700 + GST. We accept debit, e-transfer, credit card. 50% non-refundable down-payment is due before course material will be shipped.

Please provide proof of your medical licence here.

Maximum file size: 134.22MB

Questions or Comments

Disclaimer: All information is confidential.

If you are human, leave this field blank.

Intro to Botox/Dysport/Dermal Filler Course Registration Form

Registration form

Intro to Botox / Dysport / Dermal Filler Course

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