IPG, Inc.

Membership Application

Please open up your browser window all the way, and, using the PRINT function on your browser, you may print this page, fill it out completely, and mail with your check to: IPG, Inc. Treasurer, 6475 Wallace Rd NW, Salem, OR 97304. Thank you!

Name:___________________________________

Salon Name:______________________________

Address:_________________________________

City/State/Zip:_____________________________

Home Address:____________________________

City/State/Zip:_____________________________

Bus. Phone:_______________________________

Home Phone:_____________________________

Are you currently certified with any other grooming organization? ______Yes ______No

If "Yes", tell us which organization you are certified with and in what categories (if applicable) you hold certification.

Organization:_______________________________________

Categories:___________________________________________________________

____________________________________________________________________

I will be paying my annual dues using check # ___________ (please don't send cash in the mail)

Circle amount: $75 (new members, or nonconcurrent members) $50 (if paid within 30 days of renewal date) (US FUNDS only)

Thank you for your interest, and we look forward to welcoming you as a member of IPG, Inc.!

 

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