AC72 Returning Warrior Application | Helms Medical Institute

Medical Acupuncture for Physicians
Returning Warrior Application

Primary Course Units in Tempe, AZ
Module One: November 10-13, 2022
Module Two: February 2-5, 2023
Module Three: June 1-4, 2023

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.

If you are a graduate of the basic MAFP course with a graduation date of September 2019 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
Documentation of COVID-19 vaccination
Tuition payment

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

Select the session(s) you wish to attend:*
Tuition is $2500 per session OR $6900 if payment for all three sessions is received by October 10, 2022.

Module One (November 10-13, 2022)Module Two (February 2-5, 2023)Module Three (June 1-4, 2023)

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 - by phoneCall 510-649-8488 between 9:00 AM and 2:00 PM Pacific Time or fax to 510-649-8692

Check the box below if you are a 2020-21 graduate eligible for special pricing. 2020-21 Graduate

All training activities will take place at the Tempe Mission Palms Hotel & Conference Center in Tempe, AZ. You are requested to lodge at the hotel where a group rate has been arranged. A conference day use fee of $89 per day is required of participants who choose to stay elsewhere or room with another course participant.
All participants, HMI staff, and HMI preceptors must be fully vaccinated (boosters encouraged) against COVID-19 to participate at in-person activities. Additional health and safety precautions will be implemented at the in-person teaching activities and these measures must be followed by all attendees.
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.