NeXtGen Beauty Leadership Academy
Fill out the form carefully for registration
Student name
*
First Name
Last Name
E-mail (parent)
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Male
Female
N/A
Let us know what Beauty Interest are you interested in.
*
Student IG
*
Student TikTok
*
Email (student)
*
example@example.com
Phone Number (student)
Please enter a valid phone number.
Which location will you attend?
*
Please Select
13 E College St Brownsville Week July 22-26
6074 Apple Tree Dr Suite 10 Memphis Week July 29- Aug 2
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In case of emergency...
Emergency Contact:
*
First Name
Last Name
Relationship
*
Contact Number
*
Taking Any Medications, Currently?
*
Yes
No
Please List It Here and any allergens of any.
*
My Products
*
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PAID IN FULL
There is no refunds..
$
225.00
Registration Deposit
A Deposit to secure your student seat. You can pay increments of $75 every 2 weeks. Payment has to be paid in full 2 weeks prior to first day of Leadership Camp. ****Payments need to be paid in full by July 13. There is no refunds
$
75.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Signature of Agreement of payment.
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