Introductory Botulinum Toxin and Lip Fillers Registration Form

Registration Form Introductory Botulinum Toxin &/or Lip Fillers Auckland 17/18 May

Please fill in the form below.
Full Name *

First Name Last Name

Practice Address *

Phone Number *

- Area Code Phone Number
E-mail *
example@example.com
I wish to attend

Introductory Botulinum Toxin 17 May Introductory Lip Fillers 18 May
I have deposited the following into account 12 3073 0104891 00 with my surname in CAPITAL LETTERS as a reference:

One day $1500 Both days $3000
It is not essential but these courses are designed for you so that you can bring in your own friends/clients and treat them under supervision. All injectible products will be provided.
Please advise me if you have noone to bring.
Should be Empty:

Registration Form Introductory Botulinum Toxin &/or Lip Fillers Auckland 17/18 May