Acupuncture Media Works Birthday Book Giveaway

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Welcome to our Giveaway entry page!

Please take a moment to refer to the Giveaway rules on our website.

Fill out the form below with the necessary information to enter the Giveaway.

Please note that the form you are about to fill out is specifically for entering the Giveaway without making a purchase.

To qualify, kindly ensure that all the required information is submitted.

Best of luck to you!

Entry must be received no later than June 15th, 2023, 11:59 pm. One entry per person and clinic.

First Name *

Last Name *

Email Address *

Phone number *

At what school did you study acupuncture? *

What year did you graduate acupuncture school? *

What state do you practice in? *

What is your acupuncture license number? *

What is your clinic's web address? Please paste your website credential below *

How many years in practice? *

1-3

3-5

5-8

8-12

12=18

How many patients do you see a month? *

5-10

10-30

30-50

50-100

100 or more

What's your annual income? *

$10,000 - 25,000

$26,000 - 75,000

$76,000 - 150,000

$150,000 - 300,000

For verification purposes, all information must be submitted. By submitting your entry, you agree to the terms and Conditions of the "Giveaway" - see them here

By clicking below, you acknowledge and agree to the terms and conditions of the Giveaway rules. You confirm that all the information provided on the form is true and accurate, and understand that any false or misleading information may result in disqualification from the giveaway.

Yes, I agree to the Terms and Conditions of the "Giveaway"

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