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$1,349.00
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Registration: $1,349.00
Credit Card Convenience Fee: $40.47
Total Amount Due: $1,389.47

1 - Customer Information

First Name:

Last Name:

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Email Address:

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Are you a Practice Owner?:

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Name of Account Rep who guided you, if any:

2 - Payment Information

eCheck Payment

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Name on Account:

Amount to be Charged:

Date:

Email for Confirmation:

I (we) understand that this authorization will remain in full force and effect until I (we) notify AAOPM, INC. in writing at the following:

AAOPM, Inc.
2720 East Oakland Park Blvd, #102
Fort Lauderdale, FL 33306
(954) 525-4273
(954) 358-2860 (F)

That I (we) wish to revoke this authorization.

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(3% Convenience fee ($40.47))

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3 - Billing Information

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I acknowledge that I have read and agree with the AAOPM terms of service, privacy policy, and cookie policy. California courses attendees: In order to inject during hands-on sessions, you need to be licensed to inject in California.

Amount to be charged: $1,389.47


Botulinum Toxin Training	$1,349.00 Discount already applied!
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empty cart Registration: $1,349.00 Credit Card Convenience Fee: $40.47 Total Amount Due: $1,389.47

Your Registration

1 - Customer Information

2 - Payment Information

eCheck Payment

Credit Card Payment(3% Convenience fee ($40.47))

3 - Billing Information

Credit Card Payment
(3% Convenience fee ($40.47))