Note: Doors open officially September 30th, and we are carefully reviewing each application. You will be notified when you can gain access.

First Name

Last Name

Email *

Phone *

Business Name / Practise Name

Position or Title

Social Handles

Address

Street Address

City

State

Country

Postal code

Professional Details / Trichology Sector Which of the following best describes your role? (Select all that apply):

Trichologist (Clinical & Para‑medical)

Cosmetologist (Hair & Cosmetic Care)

Dermatologist / Dermatotrichologist / Trichiatrist (physicians specializing in hair and scalp disease diagnosis and management)

General Practitioner / Family Physician (primary-care doctors capable of broad-spectrum care and referrals)

Functional Medicine Practitioner (clinicians using systems-based, root-cause investigations via lab tests, nutrition, lifestyle, stress, and genetics)

Naturopath / Holistic Practitioner (providers emphasizing natural healing, botanical and lifestyle modalities)

Dietitian / Nutritional Expert - credentialed professionals in clinical nutrition (and often functional nutrition, if trained appropriately)

Other: ___________

What’s your primary focus area or specialty?

(e.g., Hair Loss, Color, Scalp Health, Hormonal Health, Autoimmune, etc.)

🔻Training & Background

We believe in valuing both formal education and hands-on experience. Please share your background below so we can match you with the most relevant community and resources.

Where did you receive your formal training or certification?

(If applicable, include school name, country, or credentialing body.)

MIf your knowledge was gained through apprenticeship, mentorship, or independent study, please share your path here:ulti Line 5ece

We honor alternative routes to mastery — feel free to include who you trained under or how you built your expertise.

“If you trained outside of formal institutions, we’d love to hear about your path. We recognize that valuable experience comes in many forms.”

🔻Connection & Contribution

Would you like to be added to our Professional Newsletter for updates, invites, and opportunities?

Yes

Not at this time

🔻 Interested in Contributing?

We’re actively seeking expert voices to help grow and enrich our platform. If you're interested in sharing your knowledge or elevating your visibility, we’d love to hear from you.

Would you like to contribute to The Hair Wire?

Yes — I’d love to share my knowledge.

Maybe — I’d like to learn more.

Not at this time.

I’m open to contributing:

Professional Lessons or Trainings

Events or Workshops for Industry Professionals

Articles or Insights for the General Public

Case Studies or Clinical Contributions

Interviews or Panel Discussions

If selected, you’ll receive an email from one of our founders to explore how you can get involved.

We value collaboration, thought leadership, and diversity of experience — and we believe the best learning happens when we share what we know.

Anything else you’d like us to know?

(Optional open space for comments)

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.