Name* Date of Birth Phone* Street Address/P.O. Box City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code* Email* How will you provide payment today?I am paying the $250 deposit online today.I am paying the full tuition before December 1, 2018 for $2,400.I am paying the full tuition after December 1, 2018 for $2,500.I am paying the $250 deposit online today and I am interested in setting up a payment plan to finance the balance of my tuition payment.I am paying the $250 deposit and would like to negotiate a barter for goods/services as partial payment for my tuition. If you are interested in setting up a payment plan to finance the remaining balance of your tuition. Please provide a proposal here for your payment agreement with payment dates and amounts. If you are interested in trading or bartering for a partial payment of your tuition, please include a detailed description of your offering here. Please Tell Us a Little About Yourself How did you hear about this program? Have you studied herbalism before? If so, with whom? Where? Have you studied botany before? Do you currently use herbs for your own health care? Tell us about this. How do you hope to use the information you will receive in this program? Do you have any training in other healing modalities (medical license, massage therapist, acupuncturist, etc.)? Is there anything else you would like us to know about you before you submit your registration?