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IAFA Application - Medical Professional

Please enter your name as you wish it to appear on your membership certificate

Address and Contact Information

Education and Training

Please indicate Area of Practice: *

Continuing Education and Training

BOTOX and Dermal Fillers Experience

Education Hours in last 3 years *
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Experience in BOTOX and Dermal Filler *

Annual Payment Information

Levels of Accreditation:

Membership: $450

Fellowship: $499

Mastership: $499

Diplomate: $499

Choose Payment Type *

If paying by check, please make payable to INTERNATIONAL ACADEMY OF FACIAL AESTHETICS and mail to the address below. Your application will be complete once we receive both your form and check payment.

International Academy of Facial Aesthetics

17501 Biscayne Boulevard, North Miami Beach, FL 33160

If paying online by credit card, please continue after submitting this form, you will be directed through the secure credit card payment process.

​I understand that I have the option to print this form, sign, and fax to (305) 938-5018. By submitting online, I am authorizing the Internatioonal Academy of Facial Aesthetics to process my application for the selected Levels of Accreditations. If paying by credit card, I understand that membership will be renewed every 12 months from the date of joining and automatically charged to my credit card on file. I understand that I can call to cancel at any time and a prorated refund will be offered.

Please type in your full name to act as your signature in full agreement with these terms and conditions. *
Terms and Conditions *



2019 IAFA Meeting

2018 IAFA Meeting