Enrollment Form - PsychAromatica Level 1

Please fill out the following form and press the submit button when ready. Module 1 of the course will be sent to you by mail on receipt of your payment of £295 (payment options at end of form).

Personal Details

Full Name: *

Address:

Phone: i.e. +44.123456789

Email: *

Personal Information

Do you have previous experience with complementary therapies, if so what?:

Please describe in brief why you want to do this course?:

Are taking any medication on a regular basis? If so what (some essential oils interfere with some medication)?:

Are you pregnant? Essential oils should be used with caution when pregnant.:

Level 2

Are you interested in continuing to Level 2?:

Yes

Not sure

If yes, where?:

Payment

Please select your preferred method of payment and currency.

Method:

Paypal

Bank Transfer

Cheque or international money order (UK sterling)

Enrollment Form - PsychAromatica Level 1

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