Your Registration

Online Registration is only for new customers; if you are an existing member please send an email to info@empiremedicaltraining.com with your request for registrations. If you have any questions please call 866.366.1576.


Botulinum Toxin Training -	$0.00 remove
Feb 08 2020 Dallas, TX The Westin Dallas Downtown

Physician Medical Weight Loss Training -	$0.00 remove
Jul 26 2020 Orlando, FL Hotel to be announced

PDO Thread Lift Training I & II -	$0.00 remove
Jun 13 2020 Empire-Virtual-Training LiveStream / Online Training

Cosmetic Laser Courses and Certification -	$699.00 remove
Jul 11 2020 Empire-Virtual-Training LiveStream / Online Training

THE Pain Show -	$999.00 remove
Aug 28 2020 -Aug 29 2020 Empire-Virtual-Training LiveStream / Online Training

Advanced Pain Management -	$0.00 remove
Oct 03 2021 Empire-Virtual-Training LiveStream / Online Training

Complete Dermal Filler Training -	$0.00 remove
Jun 04 2022 Naples, FL Naples Grande Beach Resort

Botulinum Toxin Training -	$0.00 remove
Jul 10 2022 New York City, NY Jay Suites Fifth Avenue

Sub-Total: $1,698.00
(-) Discount: $200.00
remove all discount / vendor code Registration: $1,498.00 Credit Card Convenience Fee: $37.45 Total Amount Due: $1,535.45

1 - Customer Information

First Name:

Last Name:

Medical Title:

Email Address:

Telephone:

Are you a Practice Owner?:

State License #:

Name of Account Rep who guided you, if any:

2 - Payment Information

eCheck Payment

Account Type:

Bank (Institution) Name:

Routing Number:

Account Number:

Name on Account:

Amount to be Charged:

Date:

Email for Confirmation:

I (we) understand that this authorization will remain in full force and effect until I (we) notify EMPIRE MEDICAL TRAINING, INC. in writing at the following:

Empire Medical Training, Inc.
2720 East Oakland Park Blvd, #102
Fort Lauderdale, FL 33306
(954) 525-4273
(954) 358-2860 (F)

That I (we) wish to revoke this authorization.

Name(s):

Date:

eSignature: (Please type your full name)

Credit Card Payment
(2.5% Convenience fee ($37.45))

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CVV:

3 - Billing Information

Address:

Address 2:

City:

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State:

Zipcode:

I acknowledge that I have read and agree with the Empire Medical Training terms of service, privacy policy, and cookie policy.

Amount to be charged: $1,535.45