Your Registration

Online Registration is only for new attendees; 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.


PRP Training for Aesthetics	$1,199.00 remove
Mar 22 2021 Los Angeles, CA Marriott Anaheim

Physician Medical Weight Loss Training	$999.00 remove
Jul 26 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	$1,399.00 remove
Jul 16 2022 Atlanta, GA The Westin Buckhead Atlanta

Physician Medical Weight Loss Training	$1,299.00 remove
Jun 11 2023 Chicago, IL Sheraton Grand Chicago

Ultrasound-Guided Interventional Pain Management Procedures	$1,399.00 remove
Apr 21 2024 Atlanta, GA The Westin Buckhead Atlanta

Botulinum Toxin Training	$1,399.00 remove
Jun 02 2024 Brooklyn, NY New York Marriott at the Brooklyn Bridge

Complete Dermal Filler Training	$1,399.00 remove
Jun 22 2024 Ann Arbor, MI Weber's Boutique Hotel

Sub-Total: $9,792.00
(-) Discount: $200.00
remove all discount / vendor code Registration: $9,592.00 Credit Card Convenience Fee: $239.80 Total Amount Due: $9,831.80

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:

Would you bring your own model?: (if applicable)

Would you like to participate as a model for others?: (if applicable)

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 ($239.80))

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.

Amount to be charged: $9,831.80