Name* Email* Phone* Street Address/P.O. Box* City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code* Date of Birth Choose your program option and payment details Choose your program option and payment details. Learn more about our registration and payment details. Deposit of $100 today. Tuition balance ($800) on March 1, 2021Deposit of $100 today. Monthly payments ($200) March – July 2021 Please Tell Us a Little About Yourself How did you hear about this program? Briefly describe your herbal education experiences to date. We define herbal education as formal study in an herbal training program (online or in person), independent study (books, webinars, audio recordings), apprenticeships, and any herb conferences you’ve attended. For each item listed, please include instructor/author name, class/webinar/book title, number of hours and date completed. What are your top five herbal reference books? Are you currently working with clients to provide herbal healthcare? If so, please tell us about your practice. If not, do you intend to practice as a clinical or community herbalist in the future? Do you have training in other healing modalities (medical license, massage therapist, acupuncturist, etc.)? If so, please describe. Is there anything else you would like us to know before you submit your registration? After you complete this application you must submit payment for the program. When you click the button "Submit & Pay" below you will be redirected to a payment page. If you do not submit payment with your application you will not be registered for the program. Thank you!