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THE IMENA COLLECTIVE OF PROFESSIONALS
First Name
*
Last Name
*
Business Name (If you are a single person leave this blank.)
Birth Date
Street Address and Apartment Number
*
Zip Code
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Email Address
*
Telephone Number
*
Website Address
*
Social media handle / Facebook, instagram, twitter
*
Choose your professional title.
*
Salon / Spa Owner
Hair Stylist
Makeup Artist
Makeup Artist
Tell us your hourly rate (This is what you will be paid if and when you assist another professional in the Collective).
*
How would you like to get paid? Where should we send your payments when you service one of our client members?
*
Paypal
Venmo
Zelle
Cash App
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