AAOPM - Credit Card Registration

Order Summary

Botulinum Toxin Training

Feb 09, 2025

Long Island, NY

Empire Long Island, NY Center of Excellence

$1,149.00

Discount applied

Registration: $1,149.00

Credit Card Fee (3%): $34.47

Total Amount Due: $1,183.47

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1 Customer Information

First Name *

Last Name *

Medical Title

Email Address *

Telephone *

Are you a Practice Owner?

State License #

Account Rep (if any)

2 Payment Information

A 3% convenience fee ($34.47) will be added to credit card payments.

Card Type *

Card Number *

Exp. Month *

Exp. Year *

CVV *

3 Billing Information

Address *

Address 2

City *

Country *

State

Zip Code *

4 Review & Submit

I acknowledge that I have read and agree with the AAOPM terms of service, privacy policy, and cookie policy.

Amount to be charged: $1,183.47

1,183.47

Credit Card Payment