NAIROBI® PROFESSIONAL - REGISTRATION

NAIROBI® PROFESSIONAL REGISTRATION FORM.

Use the form below to register to become an
NAIROBI® PROFESSIONAL and receive
your NAIROBI® PROFESSIONAL
User ID and Password

Please be advised your User Id and Password
will be e-mailed to you opon receipt of
a copy of your cosmetology license.

Please provide the following contact information:

*Required fields are in red

Name*
Title
Street Address*
Address (cont.)
City*
State/Province*
Zip/Postal Code*
Country*
Home Phone
E-mail

Please provide the following salon contact information:

Salon Name*
Street Address*
Address (cont.)
City*
State/Province*
Zip/Postal Code*
Country
Work Phone*
FAX
E-mail*
URL

Please provide the following license information.

License number?
Enter the date of expiration :	-- mm/dd/yy
State License Issued by :

Please be advised you will be sent your User ID and Password
once we receive a current copy of your license.

You may submit your license to Nairobi®
Professional by mail, fax or e-mail to:

mail a copy of license to:
Nairobi® Professional
CHAPMAN PLAZA
22 HOWARD CREEK DRIVE
FOUNTAIN INN, SC 29644

fax a copy of license to:
1.864.862.6285

e-mail a copy of license to:
info@nairobiprofessional.com