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Please print this page, complete (in legible black ink printing), & sign this
Certified Herbalist training application,
scan your application, and then email it by email attachment to:
training@certifiedherbalists.com
Application for Training & Designation as a Certified Herbalist
Full
name:_____________________________________________________________________________________________________________
Mailing
address:________________________________________________________________________________________________________
City:_____________________________________ State: ________________
Postal Code:
__________
Country:_________________________
Day phone: (_____ )__________________ Email:____________________________________________________________________________
If I am
accepted by the Certified Herbalists Association, I will always follow and abide by the
Certified Herbalist Code of Ethics. I understand and
agree
that my professional
designation as a Certified Herbalist will be terminated if I violate the
Code of Ethics, or if I
do not pay my annual renewal
membership
dues (currently $99.00 annually, but included for the first twelve months
in the $500 tuition). To accompany this training application,
I will make payment
to the Certified Herbalist Association by
using one of the PAYPAL Credit Card Payment Options available ,
or by my
personal or
business check, or money
order payable to the Certified Herbalists Association..
If
you have completed ANY post-high school college, trade, or
technical education programs of any kind, please provide the details
including school
name, school location, year of graduation or completion
of course, subjects studied, and any other helpful info. Attach extra
sheets of paper if needed.
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Please describe in detail all
or your business/work/career experiences that you believe would be helpful
to your successful career as a Certified
Herbalist. (please include details such as skills learned, employer names and
addresses, and dates). Attach extra sheets of paper if needed.
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Please provide the names,
nature of relationship [how you know each person], company [if relevant],
complete mailing address, and current phone number
of at least three
persons who personally know your work abilities and/or general character.
Your most ideal references would be your business/professional
clients or
co-workers. Please do NOT submit references who are your relatives or
employees. Attach extra sheets if needed.
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
I
certify that the above information is totally true and complete. I
authorize my references, schools, employers, and business associates to
provide
complete information about myself to the
Certified Herbalists Association.
_________________________________________
____________________
My
Signature
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