Name (first & last):

License #: License Type: State of Issue:

Salon Name:

Home Address:
(Street address ONLY - no PO Boxes)

City: State: ZIP: Country:  

Daytime Phone Evening Phone

Email Address: FAX:

Category (Choose one Only)

Enhancement Category (Choose Junior or Senior)

Select Enhancement Junior or Senior Junior Enhancement Senior Enhancement

Select Enhancement Style Sculptured with form - Two Color Sculptured with form - One Color Traditional blended tips - Two Color Traditional blended tips - One Color White tips with refined smile line - Two Color White tips with refined smile line - One Color White tips with refined smile line - Two Color White tips with refined smile line - One Color

Mixed Media Category (Choose Junior or Senior)

Select Mixed Media Junior or Senior Junior Mixed Media Senior Mixed Media

I verify that:
All material is original, has not been used in any competition online or offline.
I am qualified to enter the chosen category.

PLEASE CHECK ONE BOX BELOW -- REQUIRED:

I am a US resident, the above information is a US street address where I receive my mail.

I am not a US resident, I can provide a US street address for my prizes
Ship my prizes to (care of Name):
Street Address:
(Street address ONLY - no PO Boxes)
City: State: ZIP: Country:  
Daytime Phone

I am not a US resident, I can not provide a US street address for my prizes. I understand due to high shipping costs and shipping restrictions, Winners will be responsible for shipping costs.

REQUIRED:
I understand my Name, address, phone number and email address will be shared with all participating companies.