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.


Sexual Dysfunction Training for Men and Women -	$0.00
Mar 13 2020 Los Angeles, CA Beverly Hills Marriott

Complete Facial Aesthetics -	$0.00
Apr 03 2020 Las Vegas, NV Bally's Las Vegas Hotel and Casino

Complete Dermal Filler Training -	$0.00
Aug 02 2020 Las Vegas, NV Bally's Las Vegas Hotel and Casino

Master Injector Series I -	$0.00
Nov 22 2020 Dallas, TX Le Meridien Dallas by the Galleria

Submental Liposuction -	$0.00
Dec 14 2020 Las Vegas, NV The Westin Las Vegas Hotel & Spa

Botulinum Toxin Training -	$0.00
Jul 25 2020 Washington, DC Hotel to be announced

Botulinum Toxin / Dermal Filler (1-Day Training) VOD only -	$0.00
Oct 23 2020 Fort Lauderdale, FL GALLERYone - a DoubleTree Suites by Hilton Hotel

Hormone Pellet Training and Therapies -	$0.00
Jan 15 2021 Las Vegas, NV The Westin Las Vegas Hotel & Spa

ACP & Biologics for Pain Management -	$0.00
Jan 30 2021 New York City, NY Intercontinental NEW YORK Times Square

Complete Dermal Filler Training -	$699.00
Aug 09 2020 Empire-Virtual-Training LiveStream / Online Training

Hormone Pellet Training and Therapies -	$699.00
Sep 12 2020 Empire-Virtual-Training LiveStream / Online Training

PRP Training for Aesthetics -	$0.00
Sep 18 2020 East Rutherford, NJ Hilton Meadowlands

Botulinum Toxin Training -	$0.00
Sep 19 2020 Los Angeles, CA Sheraton Gateway Los Angeles Hotel

Cosmetic Laser Courses and Certification -	$699.00
Dec 12 2020 Empire-Virtual-Training LiveStream / Online Training

Botulinum Toxin Training -	$0.00
Sep 13 2020 Orlando, FL Sheraton Orlando Lake Buena Vista Resort

THE Pain Show -	$0.00
Mar 27 2021 Empire-Virtual-Training LiveStream / Online Training

Integrating telemedicine in your practice -	$0.00
Aug 01 2022 Empire-Virtual-Training LiveStream / Online Training

Physician Medical Weight Loss Training -	$0.00
Nov 03 2024 Brooklyn, NY Hotel Indigo Williamsburg - Brooklyn

Sub-Total: $2,097.00
(-) Discount: $200.00
remove all discount / vendor code Total Amount Due: $1,897.00

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.