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.


Mesotherapy Training	$999.00 remove
Jan 10 2020 Las Vegas, NV Flamingo Las Vegas

PRP Training for Aesthetics	$1,199.00 remove
Jul 27 2020 Orlando, FL Hotel to be announced

Sclerotherapy for Physicians & Nurses	$1,399.00 remove
May 15 2020 Raleigh, NC Hotel to be announced

Complete Dermal Filler Training	$999.00 remove
Apr 26 2020 Charlotte, NC Hotel to be announced

PRP Training for Aesthetics	$1,199.00 remove
Feb 15 2021 New York City, NY Intercontinental NEW YORK Times Square

Botulinum Toxin Training	$1,299.00 remove
Jul 31 2021 Las Vegas, NV The Westin Las Vegas Hotel & Spa

ACP & Biologics for Pain Management	$699.00 remove
Oct 16 2020 Empire-Virtual-Training LiveStream / Online Training

Complete Dermal Filler Training	$699.00 remove
Nov 08 2020 Empire-Virtual-Training LiveStream / Online Training

Botulinum Toxin Training	$1,399.00 remove
Jul 16 2022 San Francisco, CA Grand Hyatt San Francisco

Advanced Lip Filler Injection Techniques	$1,499.00 remove
Mar 05 2023 Chicago, IL Sheraton Grand Chicago

Sub-Total: $11,390.00
(-) Discount: $200.00
remove all discount / vendor code Registration: $11,190.00 Credit Card Convenience Fee: $279.75 Total Amount Due: $11,469.75

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 ($279.75))

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: $11,469.75