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
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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