AC67 Returning Warrior Application | Helms Medical Institute

Medical Acupuncture for Physicians
Returning Warrior Application

Bolger Hotel and Conference Center, Potomac, MD
Introductory Unit: 19-23 June 2020
Clinical One: 23-27 September 2020
Clinical Two: January 2021 (dates TBA)

If you are a graduate of the basic MAFP course with a graduation date of September 2018 and later, you may select the clinical unit(s) you wish to attend. If you graduated prior to this date, you may be requested to register for all three live units due to evolving course curriculum. Contact HMI to discuss your situation and goals.

In addition to completing the application form below, the following items 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 on your interest in returning to the program and your use of acupuncture since first taking the HMI course
Tuition payment

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

Select the session(s) you wish to attend:*
Tuition is $2200 per session OR $6000 if payment for all three sessions is received by 26 February 2020.

Introductory Unit (19-23 June 2020)Clinical One (23-27 September 2020)Clinical Two (January 2021 - dates TBA)

First Name*

Initial

Preferred Name

Last Name*

Degree*

State Medical License Number*

Specialty*

Contact Information

Primary Email*

Home Address:

Street*

Street address only, no P.O. boxes.

City*

State*

Zip*

Primary Phone*

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

Secondary Phone

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

Year you completed the basic HMI course:

Indicate method of payment:*

CheckPreferred - Payable to Helms Medical Institute, 2520 Milvia Street, Berkeley, CA 94704Credit Card - onlinePay online at https://mkt.com/hmiCredit Card - by phoneCall 510-649-8488 between 9:00 AM and 2:00 PM Pacific Time or fax to 510-649-8692

All training activities will take place at the Bolger Hotel and Conference Center, Potomac, MD. You are requested to lodge at the hotel where a group rate has been arranged. A conference day use fee of $80 per day is required of participants who choose to stay elsewhere or who choose to share a room with another course participant.
For additional information about this course, call 510-649-8488 or e-mail mafp@hmieducation.com.