THE FIVE STAR ELECTROLOGISTS GUILD™

MEMBERSHIP APPLICATION

 

There is a $200 annual membership to join the Five Star Electrologist's Guild™. Please click here to submit your application fee prior to submitting the below information. The below form requests 3 files (Personal photo, Biography and Logo). If the combined size of these files is larger than 2mb, please email the files to fivestar@bostonschoolofelectrology.com.



Personal Name:   

  

Name of Practice:

 


Electrologists License Verification With Expiration:
 


Business License Verification With Expiration:

 

Address 1:

 

Address 2:
 


City:

  

State / Province:

 

Postal / Zip Code:

 

Country:

 

Telephone Number:

 


Fax Number:

 


Hours of Practice:
 


Other Office Locations:
 


Rates (optional but not recommended):

 

Please Describe Your Practice:
 


Modes of Treatment:

 

Do You Accept Credit Cards?

              Yes              No
         
                    
Email Address:
  
               

         
                    
Web Site Address:

               
         
                    
Personal Photo (jpg, less than 100k):

               
         
                    
Personal Biography (Word or PDF format):

               
         
                    
Business Logo:

               
         
                    
Specialties (optional):
             1.
             2.

             3.



Please click the below button ONE time and be patient if you are sending files. The process could take several minutes, depending on your internet connection. If you experience problems or have questions, please send a detailed email to fivestar@bostonschoolofelectrolysis.com.

                        



 








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