Practitioner's Registration Page

Samara Botane offers a 10% discount to Licensed Health Professionals, and Certified Aromatherapy and Alternative Health Practitioners, for either online or phone sales. To qualify, we must have your license information on file. You may submit a copy of your license via fax 360.862.0244, or fill out the details about your license below online.

Once your qualifying information has been received and reviewed, we will set you up in our computer and you will then receive a 10% discount on all orders (except for bottles and jars, which we sell at a low markup to everyone). This discount is in place of our 5% discount for web orders. Sale discounts that we offer are in place of this discount if they are greater.

Our Privacy Policy - We will use your information submitted here only to verify that you are eligible for our discount. If you check this box we will add you to our e-mail list and occasionally send you information about our products, web site, and other information. If you check this box we will add your name to our snail-mailing list and may send you product or price information. We will not sell your name to anyone else, although we may send you information about Aromatherapy events that we are not directly sponsoring.

Items in Bold are Required

Type of eligibility requested:   Licensed Professional, including nurse, doctor, massage, or other.
                                                    Practicing Certified Aromatherapist or Alternative Health Practitioner

First Name Last Name

Business Name

Address

City State Zip Code

E-Mail Address Phone

If you are a licensed Health or Alternative Health Practitioner, enter information about your license here.

Type of License State Licensed by

License Number Expiration Date

If you are a practicing Aromatherapist or Alternative Health Practitioner without a license, please list your training and courses, certifications, or other qualifications here. (List school or teacher where appropriate):