Registration
Electronic Registration
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Your name:
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Address:
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State:
City:
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Phone:
APRIL--19th,20th,21st--april--26th,27th,28th
MAY--10th,11th,13th--may--17th,18th,19th
JUNE--14th,15th,16th--june-21st,22,23
JULY--12th,13th,14th--july--19th, 20th,21st
AUGUST--9th,10th,11th--aug--16th,17th,18th
SEPTEMBER--13th,14th,15th--sept--20th,21st,22nd
OCTOBER--11th,12th,13th--oct--18th,19th,20th
NOVEMBER--8th,9th,10th--nov--15th,16th,17th
DECEMBER--6th,7th,8th--dec--13th,14th,15th
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Email:
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Select your First choice:
Select your Second choice:

Please select from the class schedule your first choice and second choice for training.

For me to maintain a high level of student/teacher ratio, my classes are limited to 2 students for better
hands on training

Class choices are on a first come, first serve basis, so make your request early to ensure your first choice.

Beginners Class------7 Days---or 3 weekends-Sat,Sun,Mon-$4,000

Advanced Class---2 Days---$1,300---3 Days--$1,500---

Beginners class fee includes a “Start up” kit ($800.00 value) providing you with all the supplies to complete
at 25 procedures, almost doubling your investment for your training. This is designed to eliminate all the
worries of “what will I need”, waiting for your supplies to arrive and get you started.
Right away performing permanent cosmetics applications

( ) I have enclosed my Non-Refundable deposit of $800.00 to reserve my seat

and purchase my supplies. Balance is due before day of class.

( ) I understand some states require Technicians to work with a Physician

and  I will find out the fact and legalities respecting my city and state before

class. A good source for this information is
www.spcp.org click on your state.
add any additional comments below:
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I except all major credit cards.
Please call my office when paying with credit card. 260-563-3240
You are also welcome to mail in your payment.
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