DIAMOND BEAUTY ACADEMY Course Registration Form

Registration Form

Fill out the form carefully for registration
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail
example@example.com
Mobile Number
Phone Number
Work Number
Company
Courses*

My Products

Product Name Product Image

Product Name8 WEEK COHORT

$1,500.00 Quantity

Product Name Product Image

Product Name3 DAY WORKSHOP

$750.00 Quantity

Product Name Product Image

Product NameREGSITRATION FEE

$250.00 Quantity

Beauty Catalyst Program Product Image

Beauty Catalyst Program

$ Free Quantity

Total

$0.00

Credit Card

HEADSHOT PIC OF POTENTIAL STUDENTS
MonthDayYear
Date
Additional Comments
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