KINDLY FILL OUT AND SUBMIT BY FRIDAY, JUNE 30, 2023

FULL NAME (AS IT APPEARS ON YOUR ID)

EMAIL ADDRESS

FULL ADDRESS

CITY

STATE

ZIP CODE

PHONE NUMBER

CELL PHONE NUMBER

EMERGENCY CONTACT

REQUESTING THE FOLLOWING SPECIAL EQUIPMENT FOR MY DEMONSTRATION LECTURE

AUDIO VISUAL
Lavaliere/MicrophonePower Point PresentationAudio CassetteCD PlayerLaptop

SPA EQUIPMENT
Massage TableHot Towel CabinetAdjustable Bowl / PitcherMagnifying Lamp on StandFacial ChairWorking Side TableSteamerTrolleyRobes and TowelsStool

MODEL
I will bring my own model

PLEASE PROVIDE MODEL

OTHER REQUIREMENTS OR REQUEST