This application is for licensed salon and medical professionals located in the United States. To continue to Step 2, you must upload two current documents: a valid professional license and one accepted proof-of-business document.

1. Applicant Information

First Name*

Last Name*

Email Address*

Have you experienced Bioprogramming before?*

Yes Not yet

2. Business Information

Are you the business owner?*

Yes No

If no, what is your role within the business?*

Are you authorized to make business decisions on behalf of this business?*

Yes No

Business Type*

Salon Medical Spa Hybrid - Salon and Medical Spa

Indicate your Hybrid Business Split

Salon 50% / Medical Spa 50%

Legal Business Name*

State*

Business Website

Business Instagram

Required Professional Documentation

You must upload two separate, current documents. Applications cannot be submitted without both uploads.

3. Required Document 1 - Valid Professional License

Which professional license are you providing?*

Upload Your Valid Professional License*

Accepted file types: PDF, JPG, JPEG or PNG. The license must be current, unexpired and clearly readable. Maximum file size: 10 MB.

4. Required Document 2 - Proof of Business

Which business document are you providing?*

Upload Your Proof-of-Business Document*

Accepted file types: PDF, JPG, JPEG or PNG. The document must be current, clearly readable and show the business name and/or business address. Maximum file size: 10 MB.

Notes

Additional Notes

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