Apply for FCEA Ontario Membership
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First & Last Name *
Home Address:
Street Name
City, Ontario
Postal Code *
Cell Phone: *
Home Phone: *
Email Address: *
Date of Birth: *
Certificate Language Preference: *
Business Name:
 *
Business Address:
Street Name
City, Ontario
Postal Code *
Business Phone: *
Business Website:
I'm the: *
For how many years have you worked there? *
I work: *
Modalities available at my business: *
Required
Electrolysis Equipment/Epilalor Owned: *
Does your business meet Ontario Ministry of Health & Standards? *
Date of Last Public Inspection: *
Method of Sterilization Used: *
Required
Name and address of school where you received your electrolysis training: *
I received an electrolysis: *
Required
Year of Diploma or Certificate: *
Please describe your work experience in electrolysis: *
Are you presently a member of any electrolysis organization? *
Have you ever been a member of any electrolysis organization? *
If yes, which one?
If you left, why?
How did you hear about FCEA? *
I hereby certify that the information on this form is complete and correct to the best of my knowledge. If accepted, I promise to abide by the by-laws, rules, and regulations of the Federation of Canadian Electrolysis Associations. 

Name as digital signature:
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Date of digital signature:
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