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.


Autologous Fat Transfer -	$0.00
Mar 02 2020 New York City, NY The Westin New York at Times Square

Complete Dermal Filler Training -	$0.00
Jul 12 2020 Dallas, TX Hotel to be announced

Medical Hair Loss Therapy Training -	$0.00
Jul 27 2020 Orlando, FL Hotel to be announced

Complete Dermal Filler Training -	$0.00
Nov 15 2020 Philadelphia, PA Hotel to be announced

Advanced MSK Ultrasound Guided Injections -	$0.00
Oct 18 2020 New York City, NY The Westin New York at Times Square

Botulinum Toxin Training -	$0.00
Apr 24 2021 Philadelphia, PA Sheraton Philadelphia Downtown

PRP Training for Aesthetics -	$0.00
May 02 2021 Phoenix / Scottsdale, AZ The Westin Phoenix Downtown

ACP & Biologics for Pain Management -	$0.00
Jun 11 2021 New York City, NY New York Marriott at the Brooklyn Bridge

Complete Dermal Filler Training -	$0.00
Oct 10 2020 Austin, TX The Westin Austin Downtown

Advanced Botox and Dermal Fillers (Level II) -	$0.00
Sep 26 2021 Houston, TX The Westin Houston Medical Center

Body Contouring Injectables & Adjunct Procedures -	$0.00
Nov 07 2021 Fort Lauderdale, FL The Westin Fort Lauderdale Beach Resort

Ultrasound-Guided Interventional Pain Management Procedures -	$0.00
Aug 14 2022 New York City, NY Graduate Roosevelt Island Hotel

Botulinum Toxin Training -	$0.00
Nov 12 2022 Orlando, FL Signia by Hilton Orlando Bonnet Creek

Botulinum Toxin Training -	$0.00
Apr 29 2023 Phoenix / Scottsdale, AZ Wyndham Phoenix Airport/Tempe

THE Pain Show -	$0.00
Jun 23 2023 -Jun 25 2023 New York City, NY New York Marriott at the Brooklyn Bridge

Botulinum Toxin Training -	$0.00
Aug 19 2023 Fort Lauderdale, FL Fort Lauderdale Marriott North

THE Pain Show -	$0.00
Nov 03 2023 -Nov 05 2023 New York City, NY New York Marriott at the Brooklyn Bridge

Advanced PDO Threads -	$0.00
Oct 28 2024 Empire-Virtual-Training LiveStream / Online Training

Sub-Total: $0.00
(-) Discount: $200.00
remove all discount / vendor code Total Amount Due: $-200.00

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

CONSUMER AUTHORIZATION FOR DIRECT DEPOSIT VIA ACH

I (we) hereby authorize EMPIRE MEDICAL TRAINING, INC to electronically debit my account as follows at the depository financial institution named below. I (we) agree that ACH transactions that I (we) authorize comply with all applicable law.

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% Covenience fee)

Card Type:

Credit Card Number:

Expiration Date:

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.