Neuro-Meridian Acupuncture: Intensives-The Axial Regions • Dates: July 23-26, 2020 • Cost: $2000 for 4 day Seminar

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Registration Form

Discount Code (In partnership w/ Lhasa OMS)

PERSONAL INFO:

First Name *

Last Name *

CONTACT INFO:

Please provide the billing address for the payment option you will be using for this seminar

Street (Number, Name, Apt/Suite #) *

City *

State *

Zip Code *

Country *

Cell Phone number: (xxx) xxx–xxxx *

PROFESSIONAL INFO:

Licensure and Liability requirements

As a licensed healthcare professional, is acupuncture part of your scope of practice in the state you practice? *

Yes, and I am able to provide proof of licensure

No, not at this time but I understand that it will be required prior to July 1st to participate in this training

What is your current medical professional license? *

Acupuncturist

MD certified in Medical Acupuncture

Other, and I am able to provide verification that I am licensed to perform acupuncture as a part of my scope of practice.

Required

Do you have malpractice insurance? *

Yes, and I am able to provide proof of insurance

No, not at this time but I understand that it will be required prior to March 15th to participate in this training

MEET THE INSTRUCTOR:

This seminar is not tied to the York University Program, this an opportunity to meet the instructor.

Dr. Chiang's York University Promo is linked here to offer you insight into his passion and the clinical perspective that he brings to the "Intensives" he will be teaching here in the United States.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms