I have agreed to participate in this interactive hands-on workshop session (the "Workshop") during the Combined Use of Neurotoxins (BoNTA) and Dermal Fillers for Facial Enhancement: Fundamental, Advanced, or Masters Techniques educational (CME/CE) program sponsored by Aesthetic Advancements Institute as part of my participation in the educational program. I will practice facial injection techniques on a volunteer patient of subject (the "Volunteer") prescreened and selected by me, provided by me to be an appropriate candidate for treatment, using US FDA approved injectable agents.
I have knowledge of the risks inherent in the subject facial injections and I hereby assume all responsibility of any kind which may arise in connection with my performance of facial injections, including any or all of my acts and omissions in connection therewith. I hereby agree to indemnify, defend, and hold harmless the program sponsor, Aesthetic Advancements Institute and each of their respective affiliates, licensees, assignees and parent, subsidiary and affiliated companies, and the officers, directors, shareholders, employees and agents of all such entities (all of the foregoing, collectively, the "Indemnities"), from and against any and all costs, losses, liabilities, damages and expenses, including reasonable attorneys’ fees and costs, arising out of any claim, complaint, challenge, proceeding or other action, whether by the Volunteer or otherwise, resulting from or arising out of my participation in the workshop and specifically those medical procedures identified below. I further agree to waive any and all claims of any kind that may arise with respect to Aesthetic Advancements Institute in connection with my participation in the Workshop.
I hold a current license in the state listed in my registration, and with this license I am legally able and plan to perform the following facial aesthetic injection procedures. If training outside my state of licensure, I certify that I fall within the scope of practice for my credentials in the state in which this program is being held for training purposes only. Medical procedures to be performed:
Neurotoxins (BoNTA) Injections
Dermal Filler Injections