Registration Form

Thank you for your interest in the Fundamental injectable course “Neuromodulators and Dermal Fillers”. In this class we will be focusing on upper face use of neuromodulators and lower face use of dermal fillers.

This class will contain an approximate 2-2.5 hour didactic portion to begin with, and then remainder of the time will be spent observing hands on training/ coaching providing an opportunity to experience some of the treatment techniques that were discussed in the morning lecture.

You are responsible for providing your own model, product, MD sponsorship and malpractice insurance. The cost for the class is $2,350. Botox and Filler is not included but can be purchased on site at cost. MD sponsorship and malpractice can be added on for a $150 registration fee if needed. The course fee should be paid at time of registration to secure your spot in the course. If payment and forms are not received three weeks before the course date, a $350 late registration fee will be applied*.

The cost of the course includes:

• a Training and Reference Manual
• one hour hands on training
• a stylized cerSficate
• 8 Contact EducaSon Units

Practitioners Must:

1. Be a licensed medical professional (M.D., D.O. or P.A., N.P. or R.N.). With current malpractice coverage. Or if state allows, a licensed aesthetician with MD coverage/ sponsorship. Call 844-4-INJECT with any questions.
2. FAX current medical, nursing or physician assistant license prior to the course at (310)-347-4013.

   Fundamental Registration Forms

   Course Registration for Fundamental classes

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   Fundamental Course -$2,350Fundamental Course - Torrance - $2,700Advanced Combination - $3,000Advanced Neuromodulators + NDA - $1800Master's Level - $2,900

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