Register Now | the botox course

Last Step: Fill the form below to complete registration for hands-on training

Name*
First Last
Medical Professional Designation*
Professional Licensing Number*
Email*
Phone*
Mailing Address*
Please provide a mailing address that our team can send your custom welcome package to.
Address 2

Address 2
City*

City
Province*

Province
Postal Code*

Postal Code
Country

Country
Dietary Restrictions or Special Requests
How did you hear about us?*
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If referred by a friend/colleague, what is their name?
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