Home Phone_______________________Office Phone________________________
Education: (Describe your educational background.)
Are you a therapist or health practitioner? If “yes,” please describe.
Do you do energetic healing? If “yes,” please describe.
Have you taken aromatherapy classes? If “yes,” please describe.
Why do you want to study aromatherapy? Please describe in 100 word essay.
On a scale of 1 to 5, please indicate your commitment to the study of aromatherapy.
lowest commitment 1 2 3 4 5 highest commitment
Office use only. Please do not write in this space.
Tuition:$1,000 for 9 days of classes, due one month prior to first class date. Tuition is not refundable after classes begin. However, if a class is missed, it may be made uo when space is available in another class. Make up must be taken within one year of first calss date.
An additional $100.00 is due when full registration is not received ten days prior to first calss date.
A $75.00 fee is due when submitting your final class paper.
Registration Fee:Reqirement one month prior to first class date. Enclose a $100.00 non-refundable payment with this application-registration form. This payment will be applied to tuition due.
Certication:You will receive your AromaYoga® Certification – Level 1 after you have completed the following reqirements: attended all classes, completed all homework, sucessfully passed the final exam, completed the 84 hours of practicum and turned in the reports pertaining to such, submitted your final class project which is approved by your instructors.
I have read and accept the above.
Signature_________________________________________Date_________________ Make checks payable to Clydette Clayton
Mail to: Clydette Clayton, Aromatherapy Center, 4016 Lake Glen Rd. Fairfax, VA 22033 or phone 703-222-0960