Yearly Membership Fee:

$75.00

Includes
membership pin
and certificate

Membership Application

Printable Fill-In Form 
(requires Adobe® Reader®)

   Name ____________________________________

   Name of Certificate ________________________

   Mailing Address ____________________________

   City / State / Zip __________________________

   Phone (H) _____________ Phone (W) _____________

   Fax _______________  E-Mail ___________________

   Salon / Physician Affiliation ____________________

   Please check all that apply
   Licenses:
   __ Esthetician     What State? ______
   __Cosmetologist
   __ Salon Owner
   __ Instructor
   __ Other ___________

Mail $75.00 to:

NC Aestheticians Association
2425 Kildaire Farm Road
Suite 501
Cary, North Carolina