Name *

First Name

Last Name

Are you an existing PBS Stockist? *

Yes

No

Please list name/s of individual/s attending the Device Showcase

Unsure

Lynton Excelight

Lynton 3JUVE

Pollogen Geneo

Pollogen Divine Pro

Pollogen Maximus

Dermalux LED (Tri-Wave MD, Compact Lite)

Dermalux Flex

Bio-Therapeutic Trinity

Bio-Therapeutic Platnium/Nano

Bio-Therapeutic Titan

Other (please specify in notes below)

I authorise for my credit card to be charged a $399 (per person) to confirm my booking at the 2024 PBS 2 Day Skin Summit.

OR

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