Herbal Clinic Experience July 24-28, 2017 Herbal Clinical Experience The Aurora Lights Herbal Medic Chapter is partnering with the CommonWealth Center for Holistic Herbalism to host a week-long free herbal clinic in the towns on Naoma and Whitesville in West Virginia. Clinics will occur Tuesday-Friday. Monday will serve as a set-up and coordination day to prepare for the week. Any questions can be directed to Hannah@auroralights.org. Once we receive your registration we will contact you to follow up with more information and answer any questions you may have. Personal Contact InformationName* First Last Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Emergency Contact InformationName* First Last Phone*Additional InformationTell us about your herbal medicine and general health care knowledge/experience:*Advanced herbal knowledge is not required.What are you interested in doing during the clinics? Client Registration Client Intake Apothecary Medicine-Making Community Workshops How many nights will you be staying?* Monday, July 24 Tuesday, July 25 Wednesday, July 26 Thursday, July 27 Friday, July 28 The set $75 fee covers lodging and meals Monday - Friday but we would like to know how many people will be expected at meals each day. Do you have any dietary needs or allergies?Clinical ExperienceWe are asking for a $75 donation from all volunteers. This includes meals, lodging, and a week of incredible herbal clinic experience. The Aurora Lights Herbal Medic Chapter is comprised of volunteers that have worked to harvest and create the medicines in our clinic apothecary while working on a small financial budget for the clinic. These donations will help us replenish our chapter funds and cover clinic costs. Suggested Donation*Clinic ParticipationTotal $0.00 After clicking 'Submit' you will be redirected to our PayPal account. If you would rather send a check, please address the check to Aurora Lights and send to 66 Eddy Road Morgantown, WV 26501.