1-800-599-8050  |  training@basmahameed.com  |  Facebook Twitter Youtube Linkedin Instagram

Register Now

Personal Information

First Name*
Last Name*
  Yes, sign me up to receive information from your school. I understand I may unsubscribe at any time. See ourĀ Privacy Policy
Primary Phone*
Other Phone
  Yes, you may contact me by text. I understand I can unsubscribe at any time. See ourĀ Privacy Policy
ZIP/Postal Code*
Married? Yes No
US Citizen? Yes No


Campus Details

Campus Basma Hameed Clinic Training Academy
  Yes, I'd like a personal interview!
Request a Personal Interview on
Course of Interest
Preferred Start Date


All About Me

I'm interested in these micro-pigmentation industry areas
I heard about you from
Referral Name
Tell me more about Financial Assistance


Educational Background

My High School
  I got my GED I graduated Almost done
In what year?
Other college attended
College degree
Other notes about me

Please note that completing this registration form does not guarantee acceptance into the program. Each individual who registers for the Basma Hameed Training Academy will be subject to a screening process to determine their suitability for our training. We reserve the right to refuse acceptance to any registrant, in our full discretion, that we believe should not be enrolled in our program.