Medical aesthetics Training registration

Medical Aesthetics Training
Integrating the medical knowledge with the artistic elegance of beauty

Offered by
Biomani Advanced Medical Aesthetics Certification
Fathi G. Fam, MS, MD

Why
medical aesthetics

Medical Aesthetics Registration

Deposit including registration fees: $450.00 (non-refundable)
The balance is payable on 1st day of the class & is refundable less $100.00
Total Class tuition: $2900.00 for TX or CA

Full Name
Home Address
City
State & Zip	Zip
Home phone & 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 area code
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:

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