Westgate House, Park Road, Bolton, Greater Manchester, BL1 4RF. United Kingdom. UK.
info@iabeauty.com
Tel UK +44 (0)1204 535385 Fax UK+44 (0)1204 535386
Please complete this form and print it out from your browser, & fax or post to the address above.
Please type carefully entering details exactly as you wish them to appear on your diploma.
Surname Forenames Home Address, Road Town
County/State Post/Zip Code
Country Telephone Number Email address
Business Address Road Town
Training Qualifications
Name of Training College/School
Address
Date Commenced Training
Date Training Completed
List in Order, the professional examinations you have passed (including post-graduate training)
Date Examination
Other Academic Qualification (eg University Degrees, Teaching Certificates etc.
Date Qualification
A photocopy of your diploma(s) must be posted or faxed with your application
I wish to apply for membership of International Aestheticiennes, in the following category All cover£1,000,000. Sunbed and Permanent Creation Cover £250,000. Micropigmentation Cover £500,000
Category 1 Membership with Insurance. Section 1a Please check the appropriate box Member with standard insurance £75.00
Section 1b For Advanced Cover Qualified Therapists requiring advanced cover, please add the following premium to your membership (please check the box).
Extension 1: Broken Capillaries 1-5 Years experience. £80.00 5 Years and over experience. £55.00 Extension 2: Hairdressing, Basic. £20.00 Extension 3: Hairdressing, Advanced, including basic fro Beauty Therapists. £27.00 Extension 4: Nose Piercing includes ear piercing in lobe and cartilaginous rim. £55.00 Extension 5: Chiropody. £30.00 Extension 6: Basic Micro-Pigmentation. £180.00 Extension 7: Advanced Micro-Pigmentation including basic. £250.00 Section 2 For Mobile Therapists all risks cover on Stock and equipment Extension 8: For stock and equipment up to £750. £40.00 Extension 9: For stock and equipment up to £1,000. £60.00 Extension 10: For stock and equipment up to £1,500. £75.00 Extension 11: For stock and equipment up to £2,500. £120.00 Section 3 I.A. Member goods Extension 12: I.A. Badge. £5.00 Extension 13: Car Sticker. £2.00 Extension 14: I.A. Logo Sheet. £1.50 Membership without Insurance. Membership only (including diploma and badge). £30.00 I.A. Badge. £5.00 Car Sticker. £2.00 Logo Sheet. £1.50
Have you had any claims for professional indemnity, public or product liability made against you in the last 6 years? Are you aware of any incident, which has occurred, which may give rise to any claims, during the last 6 years?
Yes No
If Yes, please give details
My total fee is £ To pay be credit card, please indicate the card type here Master Card Visa Card Number Expiry Date
Cardholder name, as appears on card Address is different from above Date Signed (for fax or postal applications only
Please note that subscriptions run from 1st November to 31st October. Members joining after February are given a rebate on the above fees, contact Westgate House for details.
Overseas applicants, please contact Westgate House for your country's membership fee
