Maiden/other name for
certificate if different :
Home address :
Post Code :
Tick if outside UK
Yes, I am outside the UK
Daytime Tel :
Mobile Tel :
Please tick if you wish to be included on the website search feature
I would like to be included in the website's Find A Salon search feature
Name & address of present Salon or workplace:
Website address :
Time at present Salon:
Total time as Hairdresser:
Please tick all relevant boxes:
You can upload files or scans of your certificate/document(s) here:
How did you hear about State Registration? (TV, Internet, newspaper, word-of-mouth, etc)
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Please choose a reason for pending action
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