Medical Acupuncture for Physicians AC76 Application

Medical Acupuncture for Physicians
Winter – to – Fall 2025
Application

The Winter-to-Fall 2025 course has the first two primary clinical course units delivered in Tempe, Arizona and the third primary clinical course unit delivered in Potomac, Maryland (outside of Washington D.C.):

Module One: January 16-19, 2025 (Arizona)
Module Two: April 24-27, 2025 (Arizona)
Module Three: September 11-14, 2025 (Maryland)

The final day of each in-person module ends at noon local time.

There will also be additional shorter meetings delivered via Zoom in between the primary units, as well as 5 hours per week of home study video and reading assignments.

In addition to completing this form, the following documents are required for your application to be considered. You must submit them via email to mafp@hmieducation.com:

Résumé / CV
Photocopy or scan of your current medical license
Statement of plans on your interest in acupuncture and how you will incorporate it into your practice. (For military applicants, please include in your statement confirmation of your base command’s endorsement of your training and an acupuncture-friendly clinical setting.)

The fields indicated with an asterisk (*) are required.

Name And Professional Information

First Name*

Middle Initial

Preferred Name*

Last Name*

Pronouns*

Date of Birth*

Degree*

State Issuing Medical License*

Medical License Number*

Specialty 1*

Specialty 2

Contact Information

Primary Email*

Military personnel and government employees must list a non-work email address for their primary email.

Work Email

Home Address:

Street*

Street address only, no P.O. boxes.

City*

State*

Zip*

Personal Phone*

Please use the format 555-555-5555 for US phone numbers.

Work Phone

Please use the format 555-555-5555 for US phone numbers.

Military Personnel & Government Employee Applicants Only

Service Branch

Military Rank

Date of end of obligated service

Tuition*

Early Bird Course Tuition: $13,600Early Bird discount through July 31.Standard Course Tuition: $14,000 by credit card, $13,850 by ACH/check$500 late enrollment fee after December 3.Full-time Resident or Fellow rate (self-pay): $12,500 by credit card, $12,350 by ACH/checkResident/Fellow rate only available if applicant is self-paying. Tuition paid by Residency/Fellowship Program is not eligible for discounted rate. $500 late enrollment fee after Dec 3.

Indicate method of payment:*

ACH (e-check)Preferred - HMI Staff will send an ACH payment link within 48 hours of application submission.CheckPayable to Helms Medical Institute, 2001 Addison Street, Suite 300, Berkeley, CA 94704Credit Card - onlinePay online at https://mkt.com/hmiCredit Card - by phoneCall 510-649-8488 between 10am and 3pm Pacific Time3rd Party PaymentSpecify:

In-person training activities in Arizona will take place at the Tempe Mission Palms Hotel & Conference Center in Tempe, Arizona, and in-person training activities in Maryland will take place at the Bolger Conference Center in Potomac, Maryland (just outside of Washington D.C.). You are requested to lodge at the hotel where a group rate has been arranged (per night: $249 / $219 / $210 + tax + [AZ only] $12.95 resort fee). A conference day use fee of $89 per day is required of participants who choose to stay elsewhere or room with another course participant.
For additional information about this course, call 510-649-8488 or e-mail mafp@hmieducation.com. Once you have submitted this online application you will receive a confirmation email.