Copyright @2019 Levics Salon

                                                    Courses Registration Form
Levics Salon
Permanent Makeup Training
Full Name:_______________________________________________________________
Address:_________________________________________________________________ ________________________________________________________________________
Phone Number:___________________________________________________________
Cell phone Number:________________________________________________________
Email:___________________________________________________________________
Current Occupation:________________________________________________________
Emergency Contact:
Full Name:_______________________________________________________________
Cell Phone:______________________________________________________________
Email:___________________________________________________________________
Please select which course you are registering for:
 Microblading and Shading/3days/English - $3,000.00
 Microblading y Sombreado/3 dias/Espanol - $3,000.00
 Micro-Pigmentation/3 days/English - $2,500.00
 Micro-Pigmentacion/3 dias/Espanol - $2,500.00
 Lash Lift and Tinting Eyebrows & Lashes/Wednesday’s/3 hours/English - $400.00 (Deposit for this class is $200.00)
 Rizados Semi-Perminente de Pestanas y Tinte de Ceja y Pestanas/Miercoles/3 horas/Espanol - $400.00 (Deposit para esta clase es $200.00)
 Scalp Pigmentation/2 days-Sunday & Monday/English - $2,000.00
 Micro-Pigmentacion Capilar/ 2 dias-Domingo y Lunes/Espanol - $2,000.00
Do you hold any professional licenses or certifications?
If yes, please mention below.
________________________________________________________________________________________________________________________________________________________
In which state are you planning on Operating at?
____________________________________________________________________________
What is making you take this course?
____________________________________________________________________________
____________________________________________________________________________
____________________________
How did you hear about us?
____________________________________________________________________________
____________________________________________________________________________
____________________________
A Non-refundable deposit of $500.00 for the training course fee is due upon registration.
The remaining balance is due the morning of the day the classes start. Your deposit will
be transferred to your balance left of the course. Our method of paying is Cash, Credit
Card/Debit Card, Money order, or Cash Check. No personal checks please. Please be
advised that there are no refunds on deposits or course fees once paid. Deposits and/or
fees are transferable to other course dates that are available and are also assignable to
another individual providing written notification and is received no later than 14 days in
advance of the course date.
Master Card No.:______________________________ Expiry:___________________
V-Code:_____________ Zip Code:________________
❏ VISA No.: __________________________________Expiry:___________________
V-Code:_____________ Zip Code:_________________
❏ Other:______________________________________________________________
By selecting “I agree” and signing and dating below you are acknowledging that you
have read and understand these policies and will adhere
to and be bound by these terms & conditions.
 I agree
Cardholder Signature:______________________________________________
Date:___/___/___
Please complete registration form and email it to:
www.levics.salon@gmail.com