Medical Aesthetics Certification registration

Medical Aesthetics Certification

Advanced Medical Aesthetics Center
Integrating the science of medicine with the artistic elegance of beauty

Certification Program

Medical Aesthetics Classes

Advanced Medical Aesthetics Registration

Deposit including registration fees: $450.00
The balance is payable on 1st day of the class & is refundable less $100.00
Total Class tuition: $2900.00 for Texas $3000.00 for California

Full Name
Home Address
City
State	Zip
Home phone with area code	Cell
Best time to call
Email
Date of Birth
Social Security Number
High school year graduated
College year graduated
Vocational training type	Year
Name of current employer
Telephone are areacode
Job title
Two references who could recommend you for the program
A) Full name
Area code & Telephone
B) Full name
Are code & Telephone
Date of class you would like to attend: Texas California
Yes. I would like to register for 3 extra days of permanent make-up
Method of payment Registration & Deposit $ 450.00
MC Visa Am Express Discover Money Order
Credit card number: EXP DATE
Name on card:
Do you need Hotel room: Yes NO
Date the application was submitted:
By submitting this form you authorize us to charge your credit card a non-refundable deposit of $450.00