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GENERAL INFORMATION

DESIRED CERTIFICATION(S)

(select all that apply)

Laser/IPL Technician

Microneedling Technician

Microblading Technician

Medical Aesthetics/Dermatology Technician

EMERGENCY CONTACT

Same address as applicant

If the emergency contact's address is different from the applicant's, please list it here:
Do you have or experience any health issues or medical concerns that could impact your training? (If yes, please explain):

EXTENDED APPLICANT INFORMATION

How did you hear about GLAM Group Canada?
When did you first become interested in these types of certifications?
Have you ever been enrolled in a medical aesthetics and/or aesthetics course?

Yes

If yes, please list the course name and school:

EDUCATION

High School:
Year Graduated:
City, Province/State:
Grade Point Average:
Other college(s), universities or extended education attended since high school:
School:
Major/Course:
School:
Major/Course:
City, Province/State:
Year Graduated:
City, Province/State:
Year Graduated:

EMPLOYMENT HISTORY

Company:
Phone Number:
Start Date:
Employer Name:
Position:
End Date:

(optional)

Company:
Phone Number:
Start Date:
Employer Name:
Position:
End Date:
I certify that all statements on this application are true and complete.
I understand that my application will not be considered complete without the applicable registration fees paid.