Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLast support, answer you Are you a hairdresser/hairstylist? *YesNoIf yes, can you describe the typical clientele you serve?BlacksLatinosWhiteFemalesMales*Please check all that apply*Are you a salon owner? *YesNo Where do you work as a hairdresser or salon owner most of the time? StateZipcodeDo you want to receive information from our Salon Wellness Coalition? *YesNoDo you want to be part of our Salon Wellness Coalition community? *YesNoIf yes, how do you think you might want to participate in our Salon Wellnes Coalition community?A lot: I want to be super active, come to meetings, help organize events, offer and receive support, resources, and informationAverage: I want to be somewhat active, go to events, receive support, resources, and informationLittle: I want to have little participation, sometimes go to events, and receive informationVery little: I want to have minimal participation and receive informationWould you be interested in participating or learning about projects to understand how chemicals in hair products or services might affect the health of hairdressers? *YesNoHow did you first hear about the Salon Wellness Coalition? *A salon ownerA hairdresserFacebookInstagramWebsiteOtherIf your answer is "other" please write your answer here belowIf you are a hairdresser, please tell us what support, resources, and information you think the hairdresser community may need from a social support group and from other hairdressers.If you want to be active in the coalition, please give us ideas of how you think you can contribute, help, and offer assistance to the hairdresser community. That is, what do you have experience with or what skills do you have that you may be able to share with the hairdresser communityEmail *Phone number *Submit
