First and Last Name*

Please Enter your first and last name that you wish to appear on your society listing.

Shipping Address*

Please Enter your shipping address that you would like your certificate mailed to.

Business Address*

Please Enter your business address that you would like to have listed on the PMSI webpage as your place of work

Business Name*

Please Enter your business/company name that you would like to have listed on the PMSI webpage as your place of work.

Primary Phone Number*

Please Enter your primary phone number that you would like to have listed on the PMSI webpage in your contact information. If you do not have a business line, enter your personal phone number and skip the next field. (BE SURE TO INCLUDE AREA CODE)

Secondary Phone Number

Please Enter your secondary phone number that you would like to have listed on the PMSI webpage in your contact information in the case you cannot be reached at your primary number. It is not required that you enter a secondary number. (BE SURE TO INCLUDE AREA CODE)

Website Address

Please Enter your business website address if applicable. This address will appear under your contact information on your P.M.S.I. listing. Double check your entry to make sure it is the exact web address to avoid delays when submitting your listing.

Email Address*

Please Enter your e-mail address that you wish to appear under your contact information on your P.M.S.I. listing. Double check your entry to make sure it is the exact e-mail address to avoid delays when submitting your listing. We will aslo use this address if you need to be contacted concerning your listing.

Technician, Trainer, or Both*

Are you a permanent makeup Technician, Trainer or Both? Please select the option in the drop down box that applies to you. Please note that if you select "Trainer" or "Both", you MAY be required to send us proof of your work,customer feedback, copies of certificates etc... to insure that your credentials are valid, and that your P.M.S.I. listing will be accurate.

Select Type of Society Listing*

Choose what type of Society listing you desire. The Basic listing includes strictly your contact information. The Enhanced listing includes your contact information, personal photo of you or your logo and a link to your existing website. If you choose a listing involving a personal photo, you will be contacted via email. All of the prices for these listing will be a reoccurring charge every month as long as you wish to stay active on the Permanent Makeup Society.

Quantity*

Enter the appropriate quantity for this item below.