Permanent Makeup Society Application
                                                                                    JOIN the Permanent Makeup Society
                                                                                start price for Listing only $25.00 per year
                                                                          Listing w/ Picture and Link to your Website only $50.00 per year
 With this membership you will receive a Certificate of Membership to hang on your wall and Business Listing in the Society's Directory website.
                                                   
                                                                      Fill out, and submit this form to start your membership                            
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Full Name: *
Address: *
You may input a PO Box
City: *
State/Province: *
Country: *
Do not abbreviate please.
Phone Number *
Any personal information entered will be used in your listing.
Alt. Phone Number:
Your Website:
If you do not currently have a website, please leave the box empty. If you are purchasing the $25.00 listing, your website will not be included.
Your Email Address: *
We may need to contact you through the email entered.
Where/ Who Did You Receive Your Training From?
Let Us Know the Category You Want To Be Listed By: *
You Can Check More Than One.
Required
What Type of Listing Do You Want? *
Text Based Listing is $25.00/year and Photo/Website Listing is $50.00/year.
Payment Options *
Choose How You Wish to Pay for the Listing
Enter Your Card Number
Only if you are paying with Debit/Credit Card    (American Express Not Accepted)
Exp date
Contact Information / Personal Check Information
If you wish to send a pesonal check to complete your payment; Make check payable to:

Ralph Childers
1324 N. Liberty Lake Rd. #237
Liberty Lake, WA 99019
USA

If you have selected to have a picture, and website included in your listing, please send us an email with the desired picture and website link to: ezpermanentmakeup@yahoo.com

If you have any further questions, you may reach us at (509) 990-0925 or (509.995.5439)
Hours of Operation:
Mon-Fri    9:00am-3:00pm pacific time
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