Registration

To be completed after official acceptance to The Visage Institute.

First Name*

Last Name*

Mailing Address*

Date of Birth*

Month

Day

Year

Age Verification: Driver’s License OR Birth Certificate*

Emergency Contact*

High School*

High School City, State

Post-Secondary Verification: Diploma/GED/Official Transcript*

Course of Study

Cosmetology (1600 hours)

Esthiology (600 hours)

Instructor (500 hours)

Financing*

Uniform Size

XS

S

M

L

XL

2XL

I certify that all information provided is accurate and true:*

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Signature

Registration Fee

$100

Non-refundable.

Address

3232 Candelaria Rd. NE

Albuquerque, NM 87107

Events

phone

505.369.9167

Email

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