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.


Anti-Aging (Modules I & II) -	$0.00
Jan 11 2020 Las Vegas, NV Flamingo Las Vegas

Thread Lift Training II -	$0.00
Apr 19 2020 New York City, NY Cornell University, ILR School *** This is an add-on workshop, be sure you have attended our PDO Thread Lift Taining (Level I) workshop before register.

Acne Therapies for an Aesthetic Practice -	$0.00
Dec 04 2020 New York City, NY The Westin New York at Times Square

Complete Dermal Filler Training -	$0.00
Jul 19 2020 Fort Lauderdale, FL GALLERYone - a DoubleTree Suites by Hilton Hotel

Botulinum Toxin Training -	$0.00
Sep 26 2020 Indianapolis, IN Hilton Downtown Indianapolis

Complete Dermal Filler Training -	$0.00
Sep 05 2020 Riverside, CA DoubleTree by Hilton Hotel San Bernardino

THE Pain Show -	$0.00
May 15 2021 Empire-Virtual-Training LiveStream / Online Training

IV Nutrition Therapies Training -	$0.00
Jul 10 2021 New York City, NY New York Marriott at the Brooklyn Bridge

Complete Facial Aesthetics -	$0.00
Aug 20 2021 Philadelphia, PA Sheraton Philadelphia Downtown

Complete Dermal Filler Training -	$0.00
Sep 18 2021 Detroit, MI Aloft Detroit at The David Whitney

Complete Dermal Filler Training -	$0.00
Jul 18 2021 Empire-Virtual-Training LiveStream / Online Training

THE Pain Show -	$0.00
Jul 31 2021 Empire-Virtual-Training LiveStream / Online Training

Advanced Botox and Dermal Fillers (Level II) -	$0.00
Oct 02 2022 Las Vegas, NV Las Vegas Marriott

Sclerotherapy for Physicians & Nurses -	$0.00
Oct 21 2022 Nashville, TN Loews Vanderbilt Hotel

Botulinum Toxin Training -	$0.00
Apr 01 2023 Cincinnati, OH Westin Cincinnati

PDO Thread Lift Training I & II -	$0.00
Jun 11 2023 Chicago, IL Sheraton Grand Chicago

Sclerotherapy for Physicians & Nurses -	$0.00
Jun 30 2023 Dallas, TX The Westin Dallas Downtown

Complete Dermal Filler Training -	$0.00
Sep 23 2023 Orlando, FL Orlando World Center Marriott

Sclerotherapy for Physicians & Nurses -	$0.00
Dec 17 2023 Detroit, MI Ann Arbor Marriott Ypsilanti at Eagle Crest

Perineural Injection Therapy (PIT) Training -	$0.00
Aug 12 2023 New York City, NY New York Marriott at the Brooklyn Bridge

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.