South Africa's only independent CPD accredited training as performed world wide - France, USA etc...
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:: Liquid Youth Training
Course Application Forms
BTX / NASHA Filler / Mesotherapy

Please note only medically qualified personnel with an active practice code are allowed to attend the course. Dentists are legally excluded to use BTX for aesthetic purposes in South Africa. By signing this application form you agree to the above.

All courses are day courses from 09H00 until 17-18H00 and each course can be taken in isolation, but in time, the essence of all does become a reality for a true aesthetic practice

Please fill in the following form COMPLETELY in order for us to process your request.
* Required Fields

   
Title Prof. Dr. Mr. Mrs. Ms.
First Name   *
Surname   *
Speciality   *
Specific Interest   *
HPCSA No   *
Vat No   *
   
Work Address  
Address   *
City   *
State/Province   *
Postal/ZipCode   *
Country   *
   
Home Address  
Address   *
City   *
State/Province   *
Postal/ZipCode   *
Country   *
E-mail   *
   
Please include country code & area code
Contact Number   *
Facsimile  
Mobile Phone  
 
Correspondence to be sent to Work Home
 
Select Course
BTX R7 500.00
HAF R8 500.00
MESO R7 500.00

Terms and Conditions
  1. Confirm registration for the course by completing this form on-line or by downloading the form and faxing it to 021 853 0760.
  2. Your place will be booked only on receipt of the registration fee and  then be confirmed in writing.
  3. Cancellations will be accepted up to two weeks prior to the event date.  A fee of R500.00 will then be charged; otherwise the full fee will be charged.
  4. The course fee includes all necessary products (i.e.: 50U BTX), study guides, CD ROM and DVD’s, a light  lunch and refreshments.
  5. If for any reason the course can not be held on the indicated date or are cancelled.
    The course administrators will either refund the full amount or schedule a different date  suitable for all. The course administrator will not accept any consequential liability irrespective of notice given in time.
  6. All course material is subject to, and protected by copyright and must not be reproduced without express written consent by the course administrators.
* I have read and accept the terms & conditions as set forth.  Please make a reservation for myself on the indicated course or courses.