Flower Essence Society
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Please tell us more about yourself in the spaces below. As a research and educational organization, we want to be in contact with practitioners to learn more about their use of flower essences. All information will remain confidential unless we ask and you grant permission to use it for educational purposes.

To continue to promote flower essence therapy as a viable healing modality, we need your input and involvement!

* Do you use flower essences for yourself and/or family?

* Do you have a professional health or counseling practice? If so, please describe your practice and any relevant degrees, licenses and/or special training. (If no practice, please write "none.")

Do you use flower essences in your practice? If so, which ones, and how are they used?

Do you do follow-up visits with your clients to check their progress?

Are you willing to share case histories for FES research and education?

Are you willing to be interviewed on your use of flower essences?

Tell us about any educational, research or other special projects you are working on that utilize flower essences or other allied therapies:

Do you have any other comments to share?

Please enroll me for membership as indicated below:
Flower Individual - $25 per year: basic level of support.
Bouquet Organizational - $50 per year: for group and commercial memberships.
Garden Supporting - $100 per year: assisting education & research.
Garden Angel Lifetime - $500: a lifelong association with our work.

Heart Blossom - In addition, I would like to make a donation of $ to support the educational and research work of Earth-Spirit, Inc. (tax-deductible in the US IRS# 94-2804926).

I would like the donation to be used for:

Any program of the Society.
Educational programs and scholarships.
Research programs.
Gotas Godparent Program (Click here for details.)

Total amount to be charged: $

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P.O. Box 459, Nevada City, CA  95959
800-736-9222 (US & Canada)
tel: 530-265-9163    fax: 530-265-0584

E-mail: mail@flowersociety.org

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