REGISTRATION FORM

AUDITION CANDIDATE INFORMATION

First Name

Last

M.I.

Date

Street Address

Apartment/Unit #

City

State

ZIP

Home Phone:

Cell

E-mail Address

Salon Name and Phone#:

Emergency Contact Name and Phone#:

Cosmetology License # Are you a citizen of the United States? Have you ever been convicted of a felony?

Issuing State/Country of License YES YES NO NO If no, are you authorized to work in the U.S.? If yes, explain YES NO

GENERAL INFORMATION
How long have you been in business? Do you have Platform Artistry experience? Do you currently use Dudley products in the salon? Do you have a Dudley Distributor? yes YES YES NO NO If Yes, explain

no If yes, what is your distributors name?

Signature

Date

Please note: All registrations must be received by January 20, 2012 by 5:00p

Dudley Beauty Corp, LLC | 1835 Eastchester Dr. | High Point, NC 27265 | 1.888.573.8210 | opportunity@dudleyq.com