Date of Course you are interested in:
Proof of licensure required for Physicians, Physician Assistants, Registered Nurses, Clinical Nurse Specialists and Nurse Practitioners. Letter from training director needed for Fellows in Training. Payment must accompany registration. Space is limited. Register early!
AAAMS ID Number (if applicable):
MD DO NP RN PA other (specify)
Name (include Titles): [required]
If you are a Physician please enclose a copy of your medical licensure and answer the following questions:
If you are a Health Allied Professional please enclose a copy of your medical licensure and answer the following questions:
ls this your first AAAMS Conference Yes No
How did hear about AAAMS?
Colleague AAAMS Web Fax Mail Google Other
I have enclosed a check in the amount of $
(please make payable to: American Association of Aesthetic Medicine & Surgery)
I hereby authorize the AAAMS to charge the below card In the amount of $
Master Card Visa Discover American Express
Name as it appears on card:
CW2 Code (3-4 digits on the back of the card)
Credit card billing address: (Required)
Cancellation Deadline for Registration: 6 weeks prior to start of course.
Requests received 6 week prior to start of course will receive a full refund less $75.00 administrative fees. Refunds will be processed one month following the close of course.
After the cancellation deadline, all fees paid to AAAMS for the conference registration are nonrefundable
Course are subject to cancellation; AAAMS will refund the registration fees in full, but is not responsible for any travel or accommodation cost or other costs incurred due to such cancellation
Registration confirmation will be e-mailed to you within 1-2 business days
I hererby agree the above terms and conditions and consent to the above charges on my credit card.
NAME: _________________________ DATE: ______________
PLEASE FAX THE ABOVE FORM TO 310-858-4400. THANK YOU.
The course will be held at:
Hyatt Regency Century Plaza
2025 Avenue of the Stars, Los Angeles, California 90067, USA
Tel: (1-310) 228 12348 Fax: (1-310) 551 355
You can make a reservation at the Hyatt Regency or the alternative hotel listed below by directly calling the property of your choice.
Crowne Plaza Beverly Hills
1150 South Beverly Drive
Los Angeles, CA 90035
If making reservations at the above hotel, please mention “Beverly Hills Aesthetics” in order to receive a special discounted rate.
Training in YOUR OFFICE (we travel to you)
• One on One Training
• Earn Revenue While You Train
• Save on Travel + Related Expenses
• Keep your practice open - No loss of Income
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