Electronic Signature: Please type your First and Last Name.
Non-Refundable and Non-Transferrable $89.00 Registration Fee:
Upon receipt of this form and your registration fee we will send confirmation of your registration.
By clicking “Submit Payment”, I authorize the National Trichology Training Institute to initiate an electronic payment in the amount specified above from the bank account on this record. I also authorize my financial institution to honor this electronic payment. Please be advised that by submitting this payment, I hereby authorize the National Trichology Training Institute to originate an ACH debit to the account provided.