| Please enroll me in the following : | ||||||
Price |
GST | Shipping | Total | |||
| Module 1 - Materia Aromatica, Essential Oil Profiles |
$400.00
|
$20.00 | $15.00 | $435.00 | ||
| Module 2 - Anatomy/Physiology/Pathology |
$250.00
|
$12.50 | $25.00 | $287.50 | ||
| Module 1 & 2 |
$575.00
|
$28.75 | $25.00 | $628.75 | ||
Enclosed is payment by cheque or money order for courses listed above. |
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| If you are taking Module 1 & 2, do you want to do them together? | Yes | No | ||||
| Do you plan to take the bodywork portion of the course? | Yes | No | ||||
| Name | ____________________ |
Birthdate | ____________________ |
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| Mailing Address | ____________________________________________________________ |
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| Telephone | ____________________ |
____________________ |
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| Education | ____________________________________________________________ | |||||
| ____________________________________________________________ | ||||||
| Present Occupation | ____________________________________________________________ | |||||
| Marital Status | ____________________________________________________________ | |||||
| Do you have any children?____________________ |
Their ages: |
____________________ | ||||
Do you have any previous training in aromatherapy?____________ |
____________________ | |||||
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________________________________________________________________________________ |
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Please tell me about your interest in aromatherapy and what you expect from the course.
(Use back of form) Return
to: |
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