Name: _____________________________ Today’s Date: ______________________________
Address: ___________________________ City/State/Zip: _____________________________
Phone: _____________________________ Birth Date: ________________________________
Referred by: ________________________ E-Mail:____________________________________
List any experiences, if any, that you have in the beauty fashion industry:
Please list date and name of classes you are registering for:
Grand Total: $______________________ Form of Payment (circle one)
Amount Paid: $______________________
Balance Due: $______________________ cash check cc mo
TERMS AND CONDITIONS/ REFUND POLICY: We require a $100 dollar non-refundable deposit
to register with the balance due on or before the start date. We reserve the right to cancel any class,
in which case deposits are 100% refundable. In all other cases, a credit that is good for one year will
be issued. Registrations are non-transferable and cannot be confirmed until we have received a
signed form and a non-refundable deposit.
I have read and understand this registration form and agree to the terms and conditions.
Signature: _____________________________________ Date: _______________________
Credit Card Info.
Card Type: (circle one) Master Card Visa Amex Discover
Name on Card: ________________________________________
Card Number: ________________________________________ Exp. Date: __________________
Amount Charged: _____________________________________
Billing Address for your credit card:
Signature: _______________________________ Date: _______________________
By signing this, I agree to the terms and conditions listed above. Please charge my credit card.