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Last Name *

First name *

Date of birth

mm/dd/yyyy

Email *

Phone number *

Address *

Apartment, suite, etc.

ZIP 5 Digits only *

city *

State *

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Password *

Confirmation *

Name as on Pro. Beauty Lic. OR
Name of your Beauty School *

Prof.Beauty Lic.#* OR
OR SCHOOL ID

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License expiration date*
OR Graduation date*

mm/dd/yyyy

How many pounds of wax
do you currently use
per month ?

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