Online Registration is only for new customers; if you are an existing member please send an email to [email protected] with your request for registrations. If you have any questions please call 888.998.1297.

$999.00
Discount already applied!

$1,299.00
Discount already applied!

$999.00
Discount already applied!

$1,299.00
Discount already applied!

$999.00
Discount already applied!

$1,199.00
Discount already applied!

Total Amount Due: $8,093.00

1 - Customer Information

First Name:

Last Name:

Medical Title:

Email Address:

Telephone:

Are you a Practice Owner?:

State License #:

Name of Account Rep who guided you, if any:

2 - Payment Information

eCheck Payment

CONSUMER AUTHORIZATION FOR DIRECT DEPOSIT VIA ACH

I (we) hereby authorize AMERICAN ACADEMY OF PROCEDURAL MEDICINE, INC to electronically debit my account as follows at the depository financial institution named below. I (we) agree that ACH transactions that I (we) authorize comply with all applicable law.

Account Type:

Bank (Institution) Name:

Routing Number:

Account Number:

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 AMERICAN ACADEMY OF PROCEDURAL MEDICINE, INC. in writing at the following:

American Academy of Procedural Medicine, 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.

Name(s):

Date:

eSignature: (Please type your full name)

Credit Card Payment
(2.5% Covenience fee)

Card Type:

Credit Card Number:

Expiration Date:

CVV:

3 - Billing Information

Address:

Address 2:

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: $8,093.00


Botulinum Toxin Training	$999.00 Discount already applied!
Apr 12 2025 Charleston, SC Hilton Garden Inn Charleston Airport

Botulinum Toxin Training	$1,299.00 Discount already applied!
Jan 11 2025 Charlotte, NC Embassy Suites by Hilton Charlotte

Botulinum Toxin Training	$999.00 Discount already applied!
Apr 12 2025 Houston, TX The Westin Oaks Houston at the Galleria

Botulinum Toxin Training	$1,299.00 Discount already applied!
Jan 18 2025 New Orleans, LA Sheraton New Orleans Hotel

Botulinum Toxin Training	$1,299.00 Discount already applied!
Jan 04 2025 Oklahoma City, OK The National, Autograph Collection

Botulinum Toxin Training	$999.00 Discount already applied!
Apr 26 2025 Phoenix / Scottsdale, AZ Hotel to be announced

Botulinum Toxin Training	$1,199.00 Discount already applied!
Feb 15 2025 Salt Lake City, UT Hotel to be announced

empty cart Total Amount Due: $8,093.00

Your Registration

1 - Customer Information

2 - Payment Information

eCheck Payment

Credit Card Payment(2.5% Covenience fee)

3 - Billing Information

Credit Card Payment
(2.5% Covenience fee)