Course Registration Form

    Course Registration Form

    Methods of payment: select one and proceed accordingly

    Check Payable to: Supramdical LLC; Send checks to:1580 Sawgrass Corporate Parkway, Suite 130, Sunrise, FL, 33323. (Please send us a copy with the tracking number)Direct Deposit (cash or check) Please deposit to: Citibank, NA, Account Name: Supramedical LLC, Account #: 9138183249, (Please send us a copy with the receipt)Credit Card (all credit card transactions will include 4% merchant fee)

    **No reservation will be confirmed until funds are cleared.



    (last three digits on back of credit card for Visa, MasterCard, and Discover. For American Express four digits on front of card)

    Card Type


    Billing Information

    I authorize SUPRAMEDICAL LLC. to charge my credit card as stated above.


    DISCLAIMER: Any individual attending this training acknowledges that all the information provided in it is intended for students, licensed estheticians, cosmetologists, spa / med-spa owners, or any other professional of the beauty industry with the sole purpose of learning, getting training, gaining experience, or purchasing the technology, and that all the information related to the technology, pricing, and manufacturing is confidential. Any person currently working, related, or associated with any competitor company or individual is not allowed in this course. Any person attending this training with the purpose of getting pricing information, teaching techniques, or product manufacturing information to be disclosed to a competitor company or individual will be considered committing corporate espionage, is illegal, and will be prosecuted accordingly. By submitting this form, you agree with the terms and certify not being associated with any competitor's company.


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