Seminar Application Form

SALON/AGENCY

Last Name: First Name: MI:	Today's Date: 11/1/2024
Seminar of Choice: NY: LISCIO HIGHLIGHT SMOOTHING SEMINAR (ADVANCED) - NEW! Date: SELECT 08/26/2013 09/16/2013 09/30/2013	Salon Tel:
Are you a: New Customer Existing Customer	Mobile Tel:
Previously Liscio Certified: Yes No If No, other TR or relaxers experience?
Current Position at the salon:
Salon/Agency Name: Salon/Agency street address:	E-mail:
City: State: Zip: SELECT AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY	Fax: