Name *

First Name

Last Name

Phone *

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What interests you most about the Herbal Alchemy program? *

Select all that apply.

Making herbal preparations

Making skincare

Learning herb profiles

Adding Herbal Medicine to my existing business

Using it as a launchpad to deeper study

Healing my family and/or community

Healing myself from a chronic condition

Want to reduce use of pharmaceuticals

Using herbs for spiritual use

Learning how to consume more herbs as food

Want to start an herbal business

If unable to attend live, do you plan to watch the class replays? *

Yes

No

Not sure

What is your preferred method of communication? *

Email, as needed

Phone call

Text or instant message

Live video call

Asynchronous video (i.e. Marco Polo)

What level of support do you typically need when taking a course? *

LOW, will reach out as needed

MODERATE, like to have access to messaging of some kind

HIGH, I tend to need a lot of support

What is your level of experience with herbal studies? *

None, just starting

Some self-study

Several years of self-study

Formal studies in an herbal program