Request Registration Information

For course registration, simply complete this form and submit. An AAI coordinator will contact you within 24 hours to answer any questions and initiate the scheduling process for your individual instructional course/s.

Due to the very high demand for AAI instructional courses, and the limited size of our hands on courses, an Aesthetic Education Liaison will contact you within 24 hours (M-Thursday) of receipt of online registrations to confirm your registration. Registrations received after 4 pm on Friday will be replied to on Monday (or next business day if holiday).

Practitioner’s Name*
Practice Name*
How did you find out about AAI?*	Select One Search Engine Colleague/Peer Manufacturer Rep AAI CE email campaign AAI City spec. email Former AAI student AAI Magazine Ad
Manufacturers	Select One Allergan Medicis Merz Valiant Other
Rep's Name
Office Contact Person
Address*
City*
State*
Country*
Zip Code*
Best telephone number to be reached at*
E-mail*
Fax
Check the instructional course/s you are interested in*
Botulinum Toxin Type A Dermal Fillers Sclerotherapy Laser Skin Care
How long have you been injecting Botulinum Toxin Type A?	N/A 0/6 months 1+yrs
How long have you been injecting Dermal Fillers?	N/A 0/6 months 1+yrs
Click all that apply, I am a licensed*
Physician/Surgeon Nurse Practitioner and practice under the supervision of a licensed physician. Physician Assistant and practice under the supervision of a licensed physician. Registered Nurse and practice under the supervision of a licensed physician. Other
In states where scope of practice allows administration of injectables by allied health professionals with less than an R.N. degree, AAI will allow this medical professional to take part in the course only if they are accompanied by their Medical Director (ie. MD, DO, PA, and in some states NP) who will pay the standard AAI program auditing fee of $250 for the course.
When are you interested in scheduling a course/s?*
How many practitioners will be taking the course/s?	1 2 3 4 5 6 7 8 9 10
Please select the diamond and click the submit button
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