Your Registration

Online Registration is only for new attendees; if you are an existing member please register through Empire's member portal.


Office Membership 2 add - Platinum Member	$3,199.00 Spring Discount Applied remove
1 Year Term 1 Yr Membership

Cosmetic Laser Courses and Certification	$1,599.00 Spring Discount Applied remove
Sep 20 2025 -Sep 21 2025 Orlando, FL Renaissance Orlando at SeaWorld

Cosmetic Laser Courses and Certification	$1,599.00 Spring Discount Applied remove
Nov 08 2025 -Nov 09 2025 Orlando, FL Renaissance Orlando at SeaWorld

PDO Threads and PRP for Hair Restoration	$1,599.00 Spring Discount Applied remove
Nov 10 2025 Orlando, FL Renaissance Orlando at SeaWorld

Fast Track: Intensive Dermal Filler Training	$3,799.00 Spring Discount Applied remove
Aug 24 2025 Fort Lauderdale, FL Empire Center of Excellence

Fast Track: Intensive Botox Training	$3,799.00 Spring Discount Applied remove
Jul 12 2025 Old Greenwich, CT Empire Old Greenwhich, CT Center of Excellence

Clear Cart discount / vendor code codes cannot be combined. Use only one per order. Total Amount Due: $15,594.00

1 - Customer Information

First Name:

Last Name:

Medical Title:

Email Address:

Telephone:

Are you a Practice Owner?:

Medical 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

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:

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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):

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eSignature: (Please type your full name)

Credit Card Payment
(2.5% Covenience fee)

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3 - Billing Information

Address:

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I acknowledge that I have read and agree with the Empire Medical Training terms of service, privacy policy, and cookie policy. California courses attendees: In order to inject during hands-on sessions, you need to be licensed to inject in California.