REGISTER EARLY! • Program expected to be over-subscribed • Significant savings for early registrants • Special rate hotel rooms are limited • Likelihood of getting the program of your choice

Fill Out Registration Form Online and Print

(Note: If you encounter a problem filling out the form online, please download the lastest FREE version of Acrobat reader. You can also download the registration form to fill it out manually.)

Select your program below by checking the appropriate boxes: Circle the amount(s) in the applicable date column and figure the total amount. Be sure to check the appropriate refundable deposit boxes and discount box, if applicable. Only registration accompanied by full payment will be processed. Postmark shall determine the date of application or withdrawal. Please attach a copy of your current medical license. A photo copy or faxed copy of this form is acceptable but signature must be included. Fees include certain supplies, audio CD's and all workbooks. Keep copy for your record.

Acupuncture Course Before 3/15 Before 4/15 Before 5/15 After 5/15   Phase 1 & 2:  6/21 to 6/28 *    11/1 to 11/8                              Core-Curriculum              300 hours $5,970* $6,130* $6,270* $6,430*   Phase 1 only: 6/21 to 6/28 ¹                      220 hrs $4,970 $5,130 $5,270 $5,430   Refundable deposit with timely return of video       instructions (must circle this item if register       for Phase 1 or core-curriculum) $500 $500 $500 $500   Phase 2 only: 11/1 to 11/8 Workshops       80 hrs       Plus 27.5 hours of home study program $2,090 $2,220 $2,320 $2,430   Refundable deposit with timely return of video       instructions (must circle this item if register       for Phase 2 only) $300 $300 $300 $300   Herbal Medicine Course Before 3/15 Before 4/15 Before 5/15 After 5/15   Full Course: 9/13 to 9/20 ¹²                     275 hrs•• $4,775 $4,900 $5,010 $5,150   Herbal Medicine Course discount for former or       current participants of Phase 1 or core-curriculum of       Acupuncture Course ($400) ($400) ($400) ($400)   Refundable deposit with timely return of video       instructions (must circle this item if register       for Herbal Medicine Course. This deposit is in       addition to the deposit for Acupuncture Course) $500 $500 $500 $500   Acupuncture Course Framable Certificate ** $70 $70 $70 $70   Herbal Medicine Course Framable Certificate** $70 $70 $70 $70   Total   ______ ______ ______ ______