EmailMe Form - Dr. Chad Deal x CosMedic: Aesthetic Alliance

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Select Course: *

Saturday, February 3rd, 2024- $1295

Would you like to bring a staff member to attend the program with you? *

Staff - $495

Not Bringing Staff

Any Additional Information?

Billing Information - When you click submit, you will be taken to our online payment portal.

Please note that payment for the course must be made in full at least 3 weeks prior to the course date. We can accommodate special billing requests (payment plan, etc.) for your convenience.

****Unless otherwise instructed here, any balance will be processed three weeks prior to the course date****

Special Instructions for billing, if any:

Terms & Conditions:

I understand that once registered, I am reserving one of a limited number of spaces in a CosMedic training course and that my reservation may prevent another practitioner from participating in the course. As such, I understand that to avoid a $399 Rescheduling Fee, I am responsible for determining my availability in advance and will advise CosMedic within three (3) calendar weeks of the course date if I am unable to attend and need to reschedule. Since class sizes are purposely kept small to ensure individualized instruction for optimal learning and CosMedic incurs costs per registrant, I understand that CosMedic offers rescheduling, but no refunds. My signature guarantees that I will take it upon myself to ensure that the procedures being taught are legally permitted in my state of licensure under my Board's current laws and legislation. My signature also guarantees that I am currently a licensed healthcare provider in good-standing with my state of licensure.

I understand that I have the option to print this form, sign, and fax to (305) 938-5018. By submitting online, I am authorizing CosMedic to process my registration for the selected course(s). *

By checking this box, I am signifying that I have read and understand these terms and conditions.

Please type in your full name to act as your signature in full agreement with these terms and conditions. *