Your Registration

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


Dental-D Membership	$4,799.00 Spring Discount Applied remove
1 Year Term

$2499 Member Add-On Course Link	$2,499.00 Spring Discount Applied remove
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Upgrade Livestream Plus to Diamond	$4,500.00 Spring Discount Applied remove
1 Year Term 1 Yr Membership

Fast Track: Intensive Botox Training	$3,799.00 Spring Discount Applied remove
Jun 14 2025 Hauppauge, NY Empire Hauppauge, NY Center of Excellence

Fast Track: Intensive Dermal Filler Training	$3,799.00 Spring Discount Applied remove
May 04 2025 Old Greenwich, CT Empire Old Greenwhich, CT Center of Excellence

Fast Track: Intensive Botox Training	$3,799.00 Spring Discount Applied remove
Dec 14 2025 San Diego, CA Empire San Diego, CA Center of Excellence

Clear Cart discount / vendor code codes cannot be combined. Use only one per order. Registration: $23,195.00 Credit Card Convenience Fee: $695.85 Total Amount Due: $23,890.85

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

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
(3.0% Convenience fee ($695.85))

Name on Credit Card:

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. California courses attendees: In order to inject during hands-on sessions, you need to be licensed to inject in California.

Amount to be charged: $23,890.85