Registration Form
Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
What is your preferred method of commumication?
*
Phone
Text message
Email
Which of these interests you?
*
Advanced Cosmetology Program 1,000 Hours
How soon are you looking to start?
*
Please Select
Now
In a few weeks
In a few months
Do you have hours from a previous school?
*
Yes
No
Which schedule best suits you.
*
Daytime
Evening
How many hours can you commit to weekly?
*
15 or more
20 or more
25 or more
30 or more
Are you able to make a payment of $500.00 each month? WE DO NOT OFFER FINANCIAL AID
*
Yes
No
Submit
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