DO NOT DELETE, EDIT OR MOVE – Needed For Registration Form

Become a JCTA Member Today!

Salon Name:
Owner First Name:
Owner Last Name:
E-mail:
Phone Number:
Fax Number:
Website:
What Services Do You Offer:


Address:
City:
Province:
Postal Code:
Billing Address:
Billing City:
Billing Province:
Billing Postal Code:
Membership:






Add Smart Tan Salon Advertising Package:
Current Insurance Exp Month:
Current Insurance Exp Day:
Current Insurance Exp Year:
Total Payment:
Duration:

Card Type:
Name on Card
Card Number Second Half:
Exp Year:
CVV:
Username:
Password (twice):
Agree to Terms: