Name *

First Name

Last Name

Are you an existing PBS Stockist? *

Yes

No

Please select which brands/devices you are interested in at the Aesthetic Device Showcase?

Unsure

Lynton Excelight

Lynton 3JUVE

Pollogen Geneo

Pollogen Divine Pro

Pollogen Maximus

Dermalux LED (MD, Triwave or Compact)

Dermalux Flex

Bio-Therapeutic Trinity

Bio-Therapeutic Platnium/Nano

Bio-Therapeutic Titan

Other (please specify in notes below)

Payment Confirmation

I authorise for my credit card to be charged a $199 (per person) to confirm my booking at the 2023 PBS 2 Day Skin Summit.

OR

I authorise for my card on file to be charged with payment