The Academy of Facial Aesthetics Interest Form

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Hi! Please share some details so we can follow-up with you with class details.

Disclaimer

Students must check with appropriate Colorado regulatory agencies to confirm program/course work will satisfy initial or renewal licensing or certification of that agency.

Email *

First & Last Name: *

Cell Phone *

Which classes are you most interested in? *

Foundations for the Aesthetic Use of Neuromodulators - State Injectables Certification, $1,500

Foundations for the Aesthetic Use of Dermal Fillers - State Injectables Certification, $2,000

Private Training, 3 Hours - No Certification, $1,500

Required

Which of the following active licenses do you have in the Status of Colorado? *

Medical Doctor (MD)

Doctor of Osteopathy (DO)

Physician Associate (PA)

Nurse Practitioner (NP)

Registered Nurse (RN)

Licensed Esthetician (LE)

Required

A copy of your responses will be emailed to the address you provided.

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