Aesthetic Training

CONFIDENTIAL

Trainee Application Form

Name.....................................................................................

Date of Birth  ........................................................................

Address..................................................................................

Qualifications..........................................................................

(GMC/GDC/Nursing) Registration No....................................

Current Position......................................................................

Daytime Telephone Number.....................................................

Email Address............................................................................

Course Date.............................................................................

Training Course:...Botox..............Fillers..................................

Need Model (£40.00 charge per model)..YES........NO.........

Dietary Restrictions..................................................................

Hepatitis B Vaccination Status.................................................

Current Medication...................................................................

Allergies...................................................................................

Driving Instructions Required.......YES...................NO.............

Hotel Accommodation Required.......YES..................NO...........

Fee Enclosed.............................................................................

How Did You Find Us.................................................................

Please note that if you want us to provide models for your training, there is an additional charge of £ 40.00 per model. 

Fees: Botox training course  £600.00   Dermal fillers course  £550.00

(Please make cheques payable to Mr. P. Sharma)

Please return this form along with the fee to our admin. office at the following address:  Aesthetic & Botox Training, PO Box 897, Peterborough PE1 9DJ.  Telephone:  0793 409 6986  Email:  info@botoxtraining.org.uk