Senior SRB Application

MrMrsMissMs

First name:

Last name:

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 :

Email :

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:

Post Code :

Daytime Tel :

Email :

Website address :

Time at present Salon:
years

Months

Total time as Hairdresser:
years

Months

Please tick all relevant boxes:
GentsLadiesAfroChildren

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)