Ancestral Apothecary Spring 2018 Courses Application

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Deposits of $100 are required to save your space in a class. For shorter-term classes, full payment is required to save your space in the class. *We are not doing payment plans at this time. If the class becomes full- we will add you to the waitlist in the order you submit your application. Deposits are refundable ONLY if you cancel more than one month before the first day of class or if class is canceled.

Payments can be made by:

Paypal/CC: https://www.paypal.me/AncestralApothecary (Please include 3% to the total of what you will be paying for paypal fees.)

Check: made out and mailed to: Ancestral Apothecary 3798 Grand Avenue Oakland, CA 94610

*FOR Retreats, full payment is due 30 days before before class.

*** If you have taken a class with us in the past-- please fill out your name and *only the information that needs to be updated (PLEASE write N/A in the sections that don't need to be updated)

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Full Name *

Past Student? *

Yes

Class(es) you are applying for *if applying for multiple classes please indicate your other class in the "Other" line *

The Curandera/o’s Toolkit- Oakland, Spring 2018, March 22-May 31st, Thurs evenings plus two Saturdays TBA.

Herbal Allies, An Introduction to Herbal Medicine, Spring 2018, March 20-May 8th, plus two Saturdays TBA

Matriz Sagrada, April 14, 21 and 28th from 11 am to 2 pm

Option 4

Остало:

Email Address *

Phone Number # *

Date of Birth *

ДД

ММ

ГГГГ

Emergency Contact Info *

Name, Relationship, Phone #

Mailing Address (Home) *

Address, City, State, Zip

Do you have any medical or accessibility needs that we need to know? *

Prefered gender pronoun

Racial/cultural/ethnic background

For the purposes of creating a safe space for the group, in what other ways do you self-identify that you'd like to specifically and explicitly let us know?

What is your background, if any, in holistic medicine, herbalism, curanderismo and/or ancestral medicine? *

What interests you about this class? *

What is your intention for this class or what do you hope to achieve? *

Anything else we should know about you?

How did you hear about the class? *

Ancestral Apothecary Newsletter

Continuing Student

Friend/Word of Mouth

Facebook

Website

Websearch

Остало:

Any questions for us?

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