Name
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First Name
Last Name
Email
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Date of Birth
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MM
DD
YYYY
Phone
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(###)
###
####
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Pronouns
How did you hear about this program?
What do you hope to learn from this program?
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Please describe any experience and/or training in herbal medicine
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What herbalists or types of herbalism work are you inspired by?
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What are your related skills in healthcare or community support if any?
Do you have any specific accessibility needs we should be aware of?
Would you be able to access this program without the reduced rate?
No
Yes
To provide an inclusive space, it can be helpful for us to know if you belong to a marginalized group, such as being trans, gender non-conforming, Black, Indigenous or a Person of Colour. Providing this information is entirely optional and can be entered here.
I have read and understand the refund policy below.
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We make plans for the program, including the number of reduced rate spots, based on the number of students enrolled in the program. We may also have to turn people away if there is more interest than spots in the program. As as result, we cannot offer refunds.
Yes
I have read and understand the COVID policy below.
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The future of COVID is unpredictable. In addition to following any mandated public health measures, we may also request masking, social distancing, or shifting to an online format in the event of major developments in COVID transmission or severity.
Yes
I am e-transfering the non-refundable $250 deposit to oren@orenhercz.ca
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Arranging for cash payment, credit card, or mailing a cheque is also acceptable. Please get in touch for these options. Also, if you are applying for a reduced rate spot, and we cannot accommodate it, this is one situation where your deposit can be refunded.
Yes