Introductory Botulinum Toxin and Lip Fillers Registration Form

Registration Form Introductory Facial Injectibles for Dentists

Please fill in the form below.
Full Name*

First NameLast Name
Practice Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Special requests
I apologise but all courses are full apart from those listed below. Please follow me on Facebook or PM me

https://www.facebook.com/thesmilefactor.co.nz/

and I will advise you when other courses open up.

From next year the format for training will be changing and I will be doing all the theory as online modules and then you only need to attend for hands on tuition. Make sure you follow me on fb to keep updated.
I wish to attend

Introduction to Lip Fillers Saturday 7 August WANAKAIntroductory Botulinum Toxin Friday 8 October AUCKLANDIntroduction to Lip Fillers Monday 18 October AUCKLANDIntroduction to Botulinum Toxin Friday 15 October AUCKLAND
I have deposited the following into account 12 3073 0104891 00 with my SURNAME in CAPITAL LETTERS as a reference:

$1600 per Botulinum course$1800 per Lip filler course
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.

Two models may attend for Botulinum toxin, one for LIP fillers.
Please advise me if you have no-one to bring

No models
Cancellation

Cancellations will be accepted providing it is made 30 days prior to the course.

50% will be refunded between 7 and 30 days and there will be no refund if a cancellation is made within 7 days of the course
Should be Empty:

Registration Form Introductory Facial Injectibles for Dentists