CBI Membership Application/Renewal Form
Please check:
New CBI Member CBI Student Member CBI Renewal CBI Associate
First Name: ______Middle Initial: ______Last Name: ______
Address: ______State: ______Zip ______
Primary Phone: ______Alternate Phone: ______
Email Address:______
Primary Area of Practice: Please Circle all that apply
Cosmetology, Esthetics, Nail Technology, Cosmetology Instructor, Barber, Barber Instructor, Associate
Electrology, Other: ______
License Number:______Statefrom which License is issued: ______
Classification: ______
(SalonOwner, Salon Employee, Independent Contractor, School Owner, Educator/Instructor)
NOTE**New Members will be assigned a CBI Member Id Number
Current CBI Members fill out ID # and CBI Affiliate which you belong to:
CBI Member ID # ______CBI Affiliate # ______
(Members after 2006 include “CBI” as your ID) Example; correct – “CBI 2468”……incorrect – “2468”
Renewing your CBI Membership
Payment forms accepted:(see membership and payment cost and information on page 2)
Check or Money Order Payment with the completedCBI Membership Application/Renewal Form to
CBI Treasurer-Jenni White
Check or Money Order Payable to: “CBI” or “Cosmetologists and Barbers of Iowa”and mail to:
Jenni White
2923 Valley High Dr
Cedar Falls, Iowa 50613 Email: Phone:319-830-0254.
Credit Card Payment - Print Registration Form with info needed for Credit Card payment found on page 2 (next page)
Credit Card Payment will have an automatic $5.00 fee added for use
Dues paid after expiration date will have an additional cost of $ 10.00/Month
(grace period 7-10 days following expiration date)
Returned checks/insufficient funds will need to pay $15.00 service charge
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CBI Membership Payment Information:
STATE MEMBERSHIP $95
Professionals holding a cosmetology, esthetics, nail tech, barber, salon owner or school owner,electrology and instructors license.
*Renew annually
Military State Membership$75
Includes any Military person (Active/Non Active). For professionals that hold that holds a cosmetology/barber, esthetics, nail tech, salon owner or school owner, electrology and instructors license.
*Renew annually
ASSOCIATE MEMBERSHIP$95
Includes all that are not Licensed
Example: School owner that does not hold a license.
*Renew annually
STUDENT MEMBERSHIP$50
Student currently enrolled in cosmetology/barber, esthetics or nail technology course at a licensed school. Student Membership is for one year.
*Renewals after a one year periodwill renew at the **State Membership rate.
******************************************************************************************************************************************Credit Card Payment Information
Please submit the following information for the CBI Treasurer to process any Credit Card Transactions using Credit Card Square. The completed attached form may be mailed, emailed or scanned to:
Jenni White
2923 Valley High Dr
Cedar Falls, Iowa 50613 Email: Phone:319-830-0254.
Please include all information to be processed with the form.
Name (as printed on card) ______
Credit card # (______-______-______-______)Expiration (__ __/__ __) Security code (______)
Address (including zip code) ______
Contact Information for processing
HomePhone(_____) ______Cell Phone (_____) ______
Work Phone (_____) ______Email ______
There will be a$5.00 fee added forprocessing when using credit cards for EACH credit transaction. To avoid this fee please pay with check or money order. If CBI Renewals are past due a $10/month will be added, if paid within the grace period, 10th of the month following expiration date, no fee will be added.
1 | Page Cosmetology and Barber of Iowa, Inc.