Form

TBPI BODY ART SPECIALIST CERTIFICATE REQUEST
Student ID #*
First Name*
Last Name*
Address*
City*
State
or Province
Country*
If your country is not listed above, add it here
Zip*
Email*
Enter email again*
Phone xxx-xxx-xxxx*
What are your immediate BODYART GOALS (check all that apply)*

Tattooist in a shop Body Piercer in a shop Open a Tattoo Shop Open a Body Piercing Shop Tattooist & Body Piercer Open a Tattoo & Piercing Shop Learn the Art of Tattooing Learn the Art of Piercing Learn All Forms of Body Art
Link to Online Portfolio or create one FREE: www.myphotoalbum.com*
Upload a Sample of your BEST Artwork (.gif .doc .xls .jpg)
FULL NAME as you want it to appear on certificate
....
Should be Empty:

TBPI BODY ART SPECIALIST CERTIFICATE REQUEST