N.C. State Beauticians & Cosmetologists Association, Inc.  -
Registration Form for Convention 2016
(please print)

       Name_______________________________________________________

       Address_____________________________________________________

      City_________________________State_______Zip Code____________

      Contact Number (_______)________-____________

      Email_______________________________________

      Cosmetology License#__________________ 

      Members Chapter #_____________________

                Choose 1 class for Sun._____________________________________________
                              (Custom Weaving, Trending Hair Braiding, Hair Color by Affirm)  


               Choose 1 class for Mon.____________________________________________
                                                            (Silk II, Dudley, Hands on Hair Cutting)

   Pre-Registration(Deadline April 1)  Members $100.00 /Non Members $125.00
    Registration          (After April 1)        Members $125.00 /Non Members $150.00

Certified Checks or Money Orders Only
Make to: NCSBACA, Inc.

Mail your registration fee & form to:

        Dr. Jennifer Baylock - 762 Amber Drive   Fayetteville, NC 28311
or
Dr. Loretta Miller -1001  Beatties Ford Road  Charlotte, NC 28216



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