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Practitioner Discount Research Program
Thank you for your interest in our Practitioner Discount Research Program. To be eligible for an ongoing discount of 20% on all of our products, you must register for the program and agree to be contacted by us for research information in the future. Please fill in and submit the form below. Your discount will go into effect once we have received and approved your application. Note: to use your discount with our On-line Store, you must create an account first.
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Name:
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First
Last
Practice/Company Name:
Address:
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Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
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Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
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Belarus
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Cyprus
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Denmark
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Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
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Afghanistan
Bahrain
Bangladesh
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Brunei Darussalam
Myanmar
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China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Phone:
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Email:
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Web Site:
General Information
Please describe your practice and list all of the modalities you offer:
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How are vibrational essences used in your practice? Are they the primary focus of your work, or do you use them to support other modalities?
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Please specify which type(s) of Alaskan Essences you already work with in your practice:
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Flower Essences
Gem Elixirs
Environmental Essences
Combination Formulas
Sprays
What other systems of essences are you using in your practice, and how long have you used them?
How do you select and administer essences to your clients?
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Do you work with children in your practice?
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Yes
No
Do you work with animals in your practice?
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Yes
No
Do you do energy work with environments, such as Space Clearing?
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Yes
No
How do you document your work with clients?
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On average, how many times do you work with a given client?
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Ex: once a month for 2 years
Please list all formal essence related training you have received, including certification programs given by other essences companies:
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Please list any formal training you have received in any other modalities you practice:
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Please use this space to provide any additional information about yourself and your work with essences: