{"id":995,"date":"2022-12-27T23:10:03","date_gmt":"2022-12-28T05:10:03","guid":{"rendered":"https:\/\/visagemedicalregina.ca\/?page_id=995"},"modified":"2023-09-25T15:50:00","modified_gmt":"2023-09-25T21:50:00","slug":"intro-to-botox-registration-form","status":"publish","type":"page","link":"https:\/\/staging-sites.juuga.com\/visagemedicalregina\/courses\/intro-to-botox-registration-form\/","title":{"rendered":"Intro to Botox\/Dysport\/Dermal Filler Course Registration Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"995\" class=\"elementor elementor-995\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-54822cb elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"54822cb\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-01d9943\" data-id=\"01d9943\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-be11cdd elementor-widget elementor-widget-heading\" data-id=\"be11cdd\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.18.0 - 20-12-2023 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h4 class=\"elementor-heading-title elementor-size-default\">Registration form<\/h4>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6f88a9a elementor-widget elementor-widget-heading\" data-id=\"6f88a9a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Intro to Botox \/ Dysport \/ Dermal Filler Course<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0acb41b elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"0acb41b\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.18.0 - 20-12-2023 *\/\n.elementor-widget-divider{--divider-border-style:none;--divider-border-width:1px;--divider-color:#0c0d0e;--divider-icon-size:20px;--divider-element-spacing:10px;--divider-pattern-height:24px;--divider-pattern-size:20px;--divider-pattern-url:none;--divider-pattern-repeat:repeat-x}.elementor-widget-divider .elementor-divider{display:flex}.elementor-widget-divider .elementor-divider__text{font-size:15px;line-height:1;max-width:95%}.elementor-widget-divider .elementor-divider__element{margin:0 var(--divider-element-spacing);flex-shrink:0}.elementor-widget-divider .elementor-icon{font-size:var(--divider-icon-size)}.elementor-widget-divider .elementor-divider-separator{display:flex;margin:0;direction:ltr}.elementor-widget-divider--view-line_icon .elementor-divider-separator,.elementor-widget-divider--view-line_text .elementor-divider-separator{align-items:center}.elementor-widget-divider--view-line_icon .elementor-divider-separator:after,.elementor-widget-divider--view-line_icon .elementor-divider-separator:before,.elementor-widget-divider--view-line_text .elementor-divider-separator:after,.elementor-widget-divider--view-line_text .elementor-divider-separator:before{display:block;content:\"\";border-bottom:0;flex-grow:1;border-top:var(--divider-border-width) var(--divider-border-style) var(--divider-color)}.elementor-widget-divider--element-align-left .elementor-divider .elementor-divider-separator>.elementor-divider__svg:first-of-type{flex-grow:0;flex-shrink:100}.elementor-widget-divider--element-align-left .elementor-divider-separator:before{content:none}.elementor-widget-divider--element-align-left .elementor-divider__element{margin-left:0}.elementor-widget-divider--element-align-right .elementor-divider .elementor-divider-separator>.elementor-divider__svg:last-of-type{flex-grow:0;flex-shrink:100}.elementor-widget-divider--element-align-right .elementor-divider-separator:after{content:none}.elementor-widget-divider--element-align-right .elementor-divider__element{margin-right:0}.elementor-widget-divider:not(.elementor-widget-divider--view-line_text):not(.elementor-widget-divider--view-line_icon) .elementor-divider-separator{border-top:var(--divider-border-width) var(--divider-border-style) var(--divider-color)}.elementor-widget-divider--separator-type-pattern{--divider-border-style:none}.elementor-widget-divider--separator-type-pattern.elementor-widget-divider--view-line .elementor-divider-separator,.elementor-widget-divider--separator-type-pattern:not(.elementor-widget-divider--view-line) .elementor-divider-separator:after,.elementor-widget-divider--separator-type-pattern:not(.elementor-widget-divider--view-line) .elementor-divider-separator:before,.elementor-widget-divider--separator-type-pattern:not([class*=elementor-widget-divider--view]) .elementor-divider-separator{width:100%;min-height:var(--divider-pattern-height);-webkit-mask-size:var(--divider-pattern-size) 100%;mask-size:var(--divider-pattern-size) 100%;-webkit-mask-repeat:var(--divider-pattern-repeat);mask-repeat:var(--divider-pattern-repeat);background-color:var(--divider-color);-webkit-mask-image:var(--divider-pattern-url);mask-image:var(--divider-pattern-url)}.elementor-widget-divider--no-spacing{--divider-pattern-size:auto}.elementor-widget-divider--bg-round{--divider-pattern-repeat:round}.rtl .elementor-widget-divider .elementor-divider__text{direction:rtl}.e-con-inner>.elementor-widget-divider,.e-con>.elementor-widget-divider{width:var(--container-widget-width,100%);--flex-grow:var(--container-widget-flex-grow)}<\/style>\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c0ccbd4 elementor-widget elementor-widget-text-editor\" data-id=\"c0ccbd4\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.18.0 - 20-12-2023 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p>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.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2a286ce elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"2a286ce\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-63b67e2\" data-id=\"63b67e2\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-360bf3d elementor-widget elementor-widget-formidable\" data-id=\"360bf3d\" data-element_type=\"widget\" data-widget_type=\"formidable.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_6_container\" data-token=\"fe9097983ee906e7d42a2e253bc7f98f\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_intro-to-botox-dysport-dermal-filler-course\"  data-token=\"fe9097983ee906e7d42a2e253bc7f98f\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Intro to Botox\/Dysport\/Dermal Filler Course<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"6\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_6\" id=\"frm_hide_fields_6\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"intro-to-botox-dysport-dermal-filler-course\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_6\" name=\"frm_submit_entry_6\" value=\"fe3ccaf991\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/visagemedicalregina\/wp-json\/wp\/v2\/pages\/995\" \/><div id=\"frm_field_33_container\" class=\"frm_form_field form-field  frm_required_field frm_inside_container frm_first frm_half\">\r\n    <label for=\"field_qh4icy23\" id=\"field_qh4icy23_label\" class=\"frm_primary_label\">Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qh4icy23\" name=\"item_meta[33]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_qh4icy23\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_qh4icy23\">First<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_34_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_half\">\r\n    <label for=\"field_ocfup123\" id=\"field_ocfup123_label\" class=\"frm_primary_label\">Last\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ocfup123\" name=\"item_meta[34]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Last is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_ocfup123\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_ocfup123\">Last<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_35_container\" class=\"frm_form_field form-field  frm_required_field frm_inside_container frm6 frm_first\">\r\n    <label for=\"field_29yf4d23\" id=\"field_29yf4d23_label\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_29yf4d23\" name=\"item_meta[35]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please enter a valid email address\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_41_container\" class=\"frm_form_field form-field  frm_required_field frm_inside_container frm6\">\r\n    <label for=\"field_crxx6\" id=\"field_crxx6_label\" class=\"frm_primary_label\">Phone #\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_crxx6\" name=\"item_meta[41]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_42_container\" class=\"frm_form_field form-field  frm_required_field frm_inside_container frm_label_float_top\">\r\n    <div  id=\"field_5v01z_label\" class=\"frm_primary_label\">Mailing Address for Course Material\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_5v01z_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tMailing Address for Course Material<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_42-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_5v01z_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tMailing Address for Course Material\t<\/label>\n\t\t<input type=\"text\" id=\"field_5v01z_line1\" value=\"\" name=\"item_meta[42][line1]\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Mailing Address for Course Material is invalid\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_42-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_5v01z_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tMailing Address for Course Material\t<\/label>\n\t\t<input type=\"text\" id=\"field_5v01z_line2\" value=\"\" name=\"item_meta[42][line2]\"  placeholder=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Mailing Address for Course Material is invalid\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_42-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_5v01z_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCity\t<\/label>\n\t\t<input type=\"text\" id=\"field_5v01z_city\" value=\"\" name=\"item_meta[42][city]\"  placeholder=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Mailing Address for Course Material is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">City<\/div><\/div>\n<div id=\"frm_field_42-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_5v01z_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tProvince\t<\/label>\n\t\t<input type=\"text\" id=\"field_5v01z_state\" value=\"\" name=\"item_meta[42][state]\"  placeholder=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Mailing Address for Course Material is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level1\" \/>\n\t<div class=\"frm_description\">Province<\/div><\/div>\n<div id=\"frm_field_42-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_5v01z_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tPostal Code\t<\/label>\n\t\t<input type=\"text\" id=\"field_5v01z_zip\" value=\"\" name=\"item_meta[42][zip]\"  placeholder=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Mailing Address for Course Material is invalid\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">Postal Code<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_38_container\" class=\"frm_form_field form-field  frm_required_field frm_inside_container\">\r\n    <label for=\"field_c09q3\" id=\"field_c09q3_label\" class=\"frm_primary_label\">How did you hear about us?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_c09q3\" name=\"item_meta[38]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_39_container\" class=\"frm_form_field form-field  frm_required_field frm_inside_container\">\r\n    <label for=\"field_b72wx\" id=\"field_b72wx_label\" class=\"frm_primary_label\">What is your current profession?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_b72wx\" name=\"item_meta[39]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_40_container\" class=\"frm_form_field form-field  frm_required_field frm_inside_container\">\r\n    <label for=\"field_1hmdd\" id=\"field_1hmdd_label\" class=\"frm_primary_label\">Are you practicing injections currently? If yes, where?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_1hmdd\" name=\"item_meta[40]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_46_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_zhtpr_label\" class=\"frm_primary_label\">Course Qualification Requirement. I am a:\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_zhtpr_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_46-0\"><label for=\"field_zhtpr-0\">\t\t<input type=\"radio\" name=\"item_meta[46]\" id=\"field_zhtpr-0\" value=\"Registered Nurse\"\n\t\t   data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Course Qualification Requirement. I am a: is invalid\" aria-invalid=\"false\"  \/> Registered Nurse<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_46-1\"><label for=\"field_zhtpr-1\">\t\t<input type=\"radio\" name=\"item_meta[46]\" id=\"field_zhtpr-1\" value=\"Licensed Practical Nurse\"\n\t\t   data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Course Qualification Requirement. I am a: is invalid\" aria-invalid=\"false\"  \/> Licensed Practical Nurse<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_46-2\"><label for=\"field_zhtpr-2\">\t\t<input type=\"radio\" name=\"item_meta[46]\" id=\"field_zhtpr-2\" value=\"Nurse Practitioner\"\n\t\t   data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Course Qualification Requirement. I am a: is invalid\" aria-invalid=\"false\"  \/> Nurse Practitioner<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_46-3\"><label for=\"field_zhtpr-3\">\t\t<input type=\"radio\" name=\"item_meta[46]\" id=\"field_zhtpr-3\" value=\"Physician\"\n\t\t   data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Course Qualification Requirement. I am a: is invalid\" aria-invalid=\"false\"  \/> Physician<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_46-4\"><label for=\"field_zhtpr-4\">\t\t<input type=\"radio\" name=\"item_meta[46]\" id=\"field_zhtpr-4\" value=\"Dentist\"\n\t\t   data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Course Qualification Requirement. I am a: is invalid\" aria-invalid=\"false\"  \/> Dentist<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_45_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n    <div  id=\"field_px8ji_label\" class=\"frm_primary_label\">Course Cost\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_px8ji_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_45-0\"><label for=\"field_px8ji-0\"><input type=\"checkbox\" name=\"item_meta[45][]\" id=\"field_px8ji-0\" value=\"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.\"  data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"Course Cost is invalid\" aria-invalid=\"false\"   aria-required=\"true\"  \/> 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.<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_44_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_mq8rn\" id=\"field_mq8rn_label\" class=\"frm_primary_label\">Please provide proof of your medical licence here.\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\" name=\"item_meta[44][]\"  data-reqmsg=\"This field cannot be blank.\"  value=\"\" data-frmfile=\"44\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file44_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file44[]\" id=\"field_mq8rn\"\n\t\t\t data-frmfile=\"44\" multiple=\"multiple\"  data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"File Upload is invalid\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Please provide proof of your medical licence here.. Drop a file here or click to upload. Maximum file size: 134.22MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Please provide proof of your medical licence here.. Choose File. Maximum file size: 134.22MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 134.22MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_37_container\" class=\"frm_form_field form-field  frm_inside_container frm_full\">\r\n    <label for=\"field_9jv0r12\" id=\"field_9jv0r12_label\" class=\"frm_primary_label\">Questions or Comments\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[37]\" id=\"field_9jv0r12\" rows=\"5\"  data-invmsg=\"Message is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_9jv0r12\"><\/textarea>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_9jv0r12\">Disclaimer: All information is confidential.<\/div>\r\n    \r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm__653e62da2882f\">\n\t\t\t\t<label for=\"frm_email_6\" >\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input  id=\"frm_email_6\" type=\"text\" class=\"frm_verify\" name=\"frm__653e62da2882f\" value=\"\" autocomplete=\"false\"  \/>\n\t\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"bwBqRoXSPid994RJK26n\/HiWEDCz0RBeFPTTfUjoyew=\" \/><div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n<\/form>\n<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>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 [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":139,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-995","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/staging-sites.juuga.com\/visagemedicalregina\/wp-json\/wp\/v2\/pages\/995","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/staging-sites.juuga.com\/visagemedicalregina\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/staging-sites.juuga.com\/visagemedicalregina\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/staging-sites.juuga.com\/visagemedicalregina\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/staging-sites.juuga.com\/visagemedicalregina\/wp-json\/wp\/v2\/comments?post=995"}],"version-history":[{"count":14,"href":"https:\/\/staging-sites.juuga.com\/visagemedicalregina\/wp-json\/wp\/v2\/pages\/995\/revisions"}],"predecessor-version":[{"id":1590,"href":"https:\/\/staging-sites.juuga.com\/visagemedicalregina\/wp-json\/wp\/v2\/pages\/995\/revisions\/1590"}],"up":[{"embeddable":true,"href":"https:\/\/staging-sites.juuga.com\/visagemedicalregina\/wp-json\/wp\/v2\/pages\/139"}],"wp:attachment":[{"href":"https:\/\/staging-sites.juuga.com\/visagemedicalregina\/wp-json\/wp\/v2\/media?parent=995"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}