Registration
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ENROLLMENT APPLICATION
(Please Print Clearly)
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Name: ______________________________________________________________________
Date: _____________________________________________
Address: _______________________________________________________________________________________________________________________
City: ___________________________________________________ State:
___________________________ Zip Code: _____________________________
Business Phone:__________________________________________________
Home Phone: ___________________________________________________
Occupation: _______________________________________________________
License Number: ______________________________________________
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TRAINING FOR WHICH I AM REGISTERING FOR:
___________________________________________________________
Date:__________________________Cost:_____________________________
___________________________________________________________
Date:__________________________Cost:_____________________________
___________________________________________________________
Date:__________________________Cost:_____________________________
• Classes outside Miami are higher in
cost depending on locale. Basic dermopigmentation training
is required for advanced dermopigmentation classes. Please
call for schedule and prices.
• A non- refundable deposit is required to hold your
place (minimum of 25% of total cost). Balance of payment
is to be made on or before the first day of the training.
Enrollment is limited.
• Please complete this application and mail with your
deposit to Charme, P. O. Box 440038. Miami, FL 33144. If
using credit card, please also complete the authorization
form below.
• For specific training, please call us. Amount enclosed:
$_____________________________________
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CREDIT CARD AUTHORIZATION |
I,__________________________________________________________
authorize CHARME SKIN CARE & COSMETICS CORP. to charge my credit
card:
Visa____ MasterCard____ American
Express/ Optima ____ Discover____
Account No.: _________________-_________________-_________________
Date of Expiration:_________________
The sum of $ _________________________
(U. S. Dollars).
______________________________________________
(authorized signature)
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Copyright 2007, Charme International.
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