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)
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