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VOD - Peptide Therapies Treatment Training	$699.00 Spring Discount Applied remove
Jan 01 2040 On Demand Course On Demand Course

Botulinum Toxin & Dermal Filler 1-Day Training	$2,998.00 Spring Discount Applied remove
Sep 20 2025 Orlando, FL Renaissance Orlando at SeaWorld

Clear Cart discount / vendor code codes cannot be combined. Use only one per order. Registration: $3,697.00 Credit Card Convenience Fee: $110.91 Total Amount Due: $3,807.91

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

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Bank (Institution) Name:

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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 ($110.91))

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3 - Billing Information

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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.

Amount to be charged: $3,807.91