aromatherapy correspondence course application

Wise Weeds Botanical Studies

Attention: Catherine Novak
485 S. Independence Blvd., Suite 111, Virginia Beach, VA 23452

757-216-8097, ext. 97

E-mail: wiseweeds@hotmail.com

REGISTRATION FOR AROMATHERAPY CORRESPONDENCE COURSE

(Please print or type)

Name ___________________________________________________________________________

Address _________________________________________________________________________

City____________________________________ State ________________ Zip Code ____________

Work Phone ______________________________ Home Ph ________________________________

Cell _____________________________________ E-mail __________________________________

Emergency Contact ______________________________ Phone ____________________________

Medical or Mental Health Conditions ___________________________________________________

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EDUCATION

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Name City/State Dates Major/Degree

College __________________________________________________________________________

__________________________________________________________________________

Trade School _____________________________________________________________________

High School _______________________________________________________________________

Prior Aromatherapy/Herbal Training ____________________________________________________

_________________________________________________________________________________

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Preferred Class/es ______________________OPTION ( )___________ Cost $___________

How did you hear about us? _________________________________ E-mail for PayPal billing:

<>Completion of this form and your payment__________________ will register you for the

course/s. Please make money orders or checks payable to Catherine Novak.
Send your information and payment to:
Catherine Novak
Wise Weeds Botanicals
485 S. Independence Blvd., Suite 111
Virginia Beach, VA 23452.
Credit Card payments accepted through PayPal on line

I have chosen the following payment option (please circle one):

<>Payment Options:

OPTION 1.)    Course Fee: $300 paid in full. Includes Text and Lesson Tests for Lessons 1 through 15
Final Exam Fee: $35. Includes certificate of completion of course when completed satisfactorily.
Materials Fee: $95 for sample bottles of 20 essential oils, carrier oils and other supplies. (Highly recommended)
TOTAL DUE: $430

OPTION <>2.) Course, Final Exam and Materials in Advance: $395.
            TOTAL DUE: $395

OPTION 3.)     Course Fees:
Lessons 1 through 4……… $100
Lessons 5 through 8……… $100
Lessons 9 through 12…….. $100
Lessons 13 through 15…….. $75<>
PLUS
Final Exam Fee: $35.
Includes Certificate of Completion of course when completed satisfactorily.

Materials Fee: $95 for sample bottles of 20 essential oils,
carrier oils and other supplies. (Highly recommended)
TOTAL DUE: $505

<>I hereby subscribe that all of the information contained in this application is true and complete. I have read
and understand all of the above.

_________________________________________________ _________________

Student Signature Date

Last Updated January 2005