Online Laser Training Course Registration - Radiant Aesthetic Solutions

PROFESSIONAL MEDICAL EDUCATION ASSOCIATION, INC.
USE THIS PAGE TO ELECTRONICALLY REGISTER FOR ONLINE COURSES.

Credit Card Payments accepted below. Checks are made to Professional Medical Education Assn, and mailed to: PO Box 997, Grove City, OH 43123.
You may also Print Out and Complete this form, then mail to the address above or fax to 305-946-0232

Electronic Registration form - all Home-Study/Online Courses
(use the separate form for In-Person Laser Seminars)

Once you have registered you will receive an email confirmation and directions within about 24 hours. Payment must be received prior to starting course.
You'll set up your own password online with the email address you provided below.
Course Manual and Slide Handouts are available as a download from the first slide in the first module of the course. Don't forget to download them.

Name*

Title / Department

Please use this field to write your name and credentials EXACTLY as you want them to appear on your certificate.

Company / Business Name

Mailing Address | Where certificate will be mailed.*

Where certificate will be mailed.

Where will the certificate be mailed?*

Home Address

Work Address

Email*

All course materials will be sent electronically via email to this address, in addition to any course status updates. Watch for emails from "Hightail" in your Spam folder.

Phone Number

Must include area code and phone number for US phone numbers.

Select Training Courses*

If you select the 2+ persons option, enter names & emails in the box below. You can also just call us later with the names & emails. If you buy the one person program, you have 30 days to add the second person for the discounted price.

Name And "CORRECT" Emails of Additional Students

Additional Students for the Programs: Please list their names as they should appear on Certificates, and a unique email to set them up. You can also call our office to add later. Make sure the email address is CORRECT. Up to 5 total additional are included in the "2+" Course Selections. An additional fee of $125 per person will apply past the initial 2 persons. You can add these people at any time in the future-no limit.

Remarks or Requests

Payment Method*

Credit Card

Check / Purchase Order

Enter either Purchase Order number or Credit Card info. No payment is required for "Free Previews." Students will have access to the online program after payment has been received for the Purchase Order. Otherwise please use CC for quicker access.

*Enter Purchase Order # or Credit Card info

Cardholder Name:

Card Number:

Expiration Date:

3 Digit Security Code on back of card:

If I am paying by credit card, I hereby authorize charges to my card for the item(s) ordered.

By placing this order and clicking the SUBMIT button below, you acknowledge that you have read the Refund Policy and agree with its terms.

Privacy Policy

You will access to the program in 24 hours or less after your order has been processed.

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Online Laser Training Registration Form