CLASS REGISTRATION FORM
Personal Information
Full Name
Date of Birth
Email Address
Phone Number
Address
Professional Background
Current Occupation / Title
License / Certification
How did you hear about the event?
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Instagram
Facebook
Referral
Website
Other
Do you have prior experience with IPL or similar devices?
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Yes
No
If yes, briefly describe:
Payment Information
Payment Method
Select method
Zelle (send payment to utroppiabm@gmail.com)
Debit / Credit Card - fee of 4% applies (Call to make the payment)
Cash (Visit our office up to 72 hours before the training)
Consent & Agreement
I understand that this course is for educational purposes only and does not replace a medical or professional license.
I agree to follow safety protocols during the hands-on portion of the training.
Register