Course Registration

* Registration Not Confirmed until Payment is Received.
Please use the form below to register online

Name
Address
City
State
Zip
Phone
Cell Phone
Fax
Medical License#
Medical Specialty
Email Address
Course Name
Accompanying Staff (Name & Title) 
  *Fees may apply and space is limited
Supplemental Training
  *Preceptors may offer additional training (additional fees required & space is limited
Comments
  Cancellation Policy: Registration is 90% refundable only if a written cancellation is received 2 weeks prior to the scheduled workshop.
Course dates & times subject to change.
 

Click here to download the registration form in PDF format and fax it to 520.574.7944
If paying by check, send completed form & check to:
American Academy of Cosmetic Gynecologists
8000 S Kolb Rd, Ste 101
Tucson, AZ 85706