Name *

First Name

Last Name

Are you an existing PBS Stockist? *

Yes

No

Want to win a Dermalux LED machine?

One entry per business. Please tick and details will be emailed to you to complete your entry.

Yes

No

Please tick if you would like to arrange a Dermalux LED presentation

Yes

No

Payment Confirmation

I authorise for my credit card to be charged a $99 (per person) holding fee to confirm my booking at the 2019 PBS 2 Day Skin Summit. After attendance of the event; this will be returned as a credit on your account.

OR

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