AHLC MEMBERSHIP FORM

Who may apply:
• Hair replacement specialists
• Hair transplant surgeons
• Specialists treating hair loss
• Manufacturers and distributors of hair replacement products

Membership Renewals:
The American Hair Loss Council promotes the highest standards of professionalism in the hair loss industry. In order to ensure that this quality of professionalism is maintained, please complete the form below and submit.

New Membership Applicants:
As policy, The American Hair loss Council requires to have specific materials on-file for each member. New membership applicants will be required to provide a copy of the following for our files. These items and mailing instructions will also be available on the following page, after submission.

1. A valid business licence
2. A valid state practicing licence
3. A business card
4. A copy of some form of print advertising (newspaper, magazine, etc.)
5. A voided, business check (if paying initial membership dues by credit card)

For Help: call The AHLC Membership Director: Betty Bugden, 570-462-1101

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Number of years at this location



Years in the hair replacement profession



Licensed as:





Certification: By submitting this form, I hereby certify that all information contained within this application is accurate and truthful. I further certify that I have the appropriate liability insurance and I have read the ahlc code of ethics as well as the ahlc advertising guidelines. Moreover, I agree to comply with the mission of the ahlc. I support the concepts and principles upon which those documents were written within my business and marketing practices.

Note: Dues to the American hair loss council may be deductible to members for federal income purposes as ordinary and necessary business expenses. Dues are not deductible as charitable contributions. Please consult your tax advisor for specific advice.

Total Costs:
Membership Renewals
: $375 per year
New Memberships: $425 ($375 plus $50 application fee)

Payment Method: Please Check One

Check, via US Mail: Mailing address will be displayed on the following page upon suscessful submission.
Credit Card: An AHLC representative will contact you and take your information in person.
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