NEW for 2010! DVD Injection Lipolysis. Order online

 

 

WORKSHOP REGISTRATION FORM

 

 

 

I like to enrol for the workshop "Complete Aesthetic Lipolysis 1 day-Workshop". The fee for the workshop is 1.980,-- EUR, and includes the listing fee (580,-- EUR inclusive statutory taxes) for one year on the IAAL`s website list of physicians practicing the Injection-Lipolysis (listing is not compulsory, but renunciation of listing does not result in returning of payment)

 

I like to enrol for the workshop "Introductional Aesthetic Lipolysis 1/2 day-Workshop". The fee for the workshop is 600.-- EUR (+Gov.Taxes). Listing in IAAL requires either the completion of the 1 day-Workshop or an additional 1/2 day Update-Workshop for advanced practitioners.

 

 

I like to enrol for the workshop "Update Aesthetic Lipolysis 1/2 day-Workshop" for advanced practitioners holding a certificate from IAAL or other renowned organisations. The fee for the workshop is 600.-- EUR (+Gov.Taxes).

 

in Vienna Date by arrangement

 

 

Address & Personal Data

 

 

 

 

Surname

 

 

 

Forename

 

 

 

Address

 

 

 

 

 

 

 

Phone

 

 

 

Fax

 

 

 

E-Mail

 

 

 

Specialisation

 

 

 

 

 

 

Cancellation policy: As soon as your receipt has been paid you get an acceptance mail by our office. If you cancel the workshop we return 75% if done more than 2 weeks in advance, 50% if done between 2 weeks and 1 week in advance. Nothing will be returned if the workshop is cancelled after 1 week before the date or in the case of “no show”. The invoice will be sent as soon as we have received your completed form. your place is guaranteed as soon as we have received your payment. In the case of short term notice payment can be done at site, if there are places available (check by mail).

 

 

 

For payment with Credit Cards:
Please write exactly as it appears on the card – fill in all details as indicated
Name on card: ________________________________________________________
Visa:
       Total Fee to be charged:  EUR _________________
Card No:  _____ _____ _____ _____/_____ _____ _____ _____/_____ _____ _____ _____/_____ _____ _____ _____
Expiration Date:  ____ / ________    CVC Code:  _______________  (last 3 digits on back of the card)
Billing Address:  ______________________________________________________________________

 

Informed Consent

 

I accept that all information disclosed during a workshop/video-workshop organized by the International Academy of Aesthetic Lipolysis and all information offered on other ways by the Academy, are the (intellectual) property of IAAL. I agree that the information may only be used for the treatment of patients in my doctor’s office. I am not entitled to disclose this information - free or against payment - to physicians, nurses, non medical practitioners or medical staff, except for the medical staff employed in my office necessary for good medical practice in the treatment of my patients.

IAAL reserves the right to assert claims for economic damages, if any. I hereby confirm that I am a licensed physician and I do know that it is my responsibility to check for the legal requirements in my country and that I will hold the IAAL, DDr.Heinrich and any other member of the Academy free of any claim due to any problem or damage arisen from the use of the information brought forward by any means. Sound, picture, film and video recordings during the workshop are not allowed.

 

Please sign to confirm, that you have read and fully understood the declaration and do agree to its content.

 

 

 

 

 

 

 

 

 

 

Date

Signature