Registration Form
iebdams.org
"Do you need 'Dr. or DRA(for Philippines Female doctors)' to be included with your name, for example, 'Joe Smith, RN'?"
Dr.
DRA
No do not use
RN
"Please mention your name below as you would like it to appear on your certificate and award."
Name
*
First Name
Last Name
Email
*
example@example.com
Mobile Number/WhatsApp Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
Date
Back
Next
Are you a
*
Individual Practitioner
Master Trainer
Academy Owner
Degree (MD, MBBS, Dermatologist, Plastic Surgeon, Maxillo Facial Surgeon, Registered Nurse, BDS, MDS etc...)
*
PLEASE EMAIL US PHOTO COPY OF YOUR MEDICAL PRACTICE LICENCE OR QUALIFICATION DOCUMENTS ON admin@imcac.org
Name of Academy/Clinic or Hospital
Back
Next
Packages
*
prev
next
( X )
Masterclass Advanced Booking
$300.00
$
300.00
Quantity
1
2
3
4
5
6
7
8
9
10
Master Class Package without stay
$1,000.00
$
1,000.00
Quantity
1
2
3
4
5
6
7
8
9
10
Train the Trainer Certification Masterclass Package without stay
$2,000.00
$
2,000.00
Quantity
1
2
3
4
5
6
7
8
9
10
Master Class Package includes Twin Sharing Stay with Breakfast for 4 nights
$1,250.00
$
1,250.00
Quantity
1
2
3
4
5
6
7
8
9
10
Master Class Package includes Private Stay with Breakfast for 4 nights
$1,400.00
$
1,400.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Submit
Should be Empty: