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Registration form

Intro to Botox/Dysport/Dermal Filler Course

Please fill out the form below to register for the Intro to Botox/Dysport/Dermal Filler Course. Once our office reviews your registration form and copy of active practicing license of RN, NP, LPN, physician or dentist, we will contact you for your payment. We will require at least 50% to send your theory and textbook. You have 72 hrs for full refund after payment is made if needed. After the 72 hrs,  deposit is non-refundable. The remaining 50% will be due at least one month prior to practicum.

Intro to Botox/Dysport/Dermal Filler Course
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I choose to waive my rights for refundable payment within the 72hrs and want my theory shipped now.
I understand, speak, read and write in English and understand what I am signing.
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