Education Request: Zoom or In Person
Submitted by
*
First Name
Last Name
Business or School Name:
*
Contact Person:
*
First Name
Last Name
Title
*
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Type of Class Requested:
*
School In Person Class *must qualify for BT education partner program
Zoom student class
Zoom instructor training
Professional/Non school video call
Class requested
Type option 1
Type option 2
Type option 3
Type option 4
Professional Status:
*
Licensed Professional
Partner School
License number
*
Class Focus (Licensed Professional):
Technology Type
*
bt-gear
bt-micro
bt-micro fusion
bt-nano
bt-sculpt
bt-accent LED
bt-accent AIR
Bio-Brasion Trinity
Bio-Ultimate Platinum
bt-titan MN
bt-ceuticals
bt-ceuticals professional/retail
No equipment owned
Serial #
*
Name of additional attendee
First Name
Last Name
License number of additional attendee
Add more
yes
no
Name of additional attendee
First Name
Last Name
License number of additional attendee
Add more
yes
no
Name of additional attendee
First Name
Last Name
License number of additional attendee
Add more
yes
no
Name of additional attendee
First Name
Last Name
License number of additional attendee
Add more
yes
no
Name of additional attendee
First Name
Last Name
License number of additional attendee
Add more
yes
no
Name of additional attendee
First Name
Last Name
License number of additional attendee
Class Focus (Partner School):
Class selection
*
Introduction to bt-gear w/bt-micro demo
bt-pro
Instructor Training
Equipment Training
bt-ceuticals
Bio-Therapeutic Technology
*
bt-analyze
bt-zoom
bt-sonic
bt-micro
bt-micro fusion
bt-nano
bt-sculpt
bt-accent LED
bt-accent AIR
Bio-Brasion Trinity
Bio-Ultimate Platinum
bt-titan MN
bt-ceuticals professional/retail
Option 1
*
Option 2
*
Option 3
*
Option 1
*
-
Month
-
Day
Year
Date
Time
Option 2
*
-
Month
-
Day
Year
Date
Time
Option 3
*
-
Month
-
Day
Year
Date
Time
Please note a preferred date, time, and any additional information below
*
Submit
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