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.


Key Steps B2C - Developing & Operating a Medical Practice -	$0.00 remove
Jun 01 2020 New York City, NY The Westin New York at Times Square

Complete Facial Aesthetics -	$0.00 remove
Jun 04 2021 New York City, NY New York Marriott at the Brooklyn Bridge

Sclerotherapy for Physicians & Nurses -	$699.00 remove
Sep 18 2020 Empire-Virtual-Training LiveStream / Online Training

Complete Dermal Filler Training -	$699.00 remove
Nov 15 2020 Empire-Virtual-Training LiveStream / Online Training

Botulinum Toxin Training -	$0.00 remove
Feb 11 2023 Dallas, TX The Westin Dallas Downtown

Sub-Total: $1,398.00
(-) Discount: $200.00
remove all discount / vendor code Registration: $1,198.00 Credit Card Convenience Fee: $29.95 Total Amount Due: $1,227.95

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 ($29.95))

Card Type:

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CVV:

3 - Billing Information

Address:

Address 2:

City:

Country:

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: $1,227.95