Medical Acupuncture for Physicians AC77 Application

Medical Acupuncture for Physicians
Spring – to – Fall 2025
Application

The Spring-to-Fall 2025 course has three primary clinical course units delivered in Potomac, Maryland (outside of Washington D.C.):

Module One: March 13-16, 2025
Module Two: June 19-22, 2025
Module Three: September 11-14, 2025

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 7 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
Copy of your current medical license (photo, PDF, screenshot) – must show expiration date
A statement of plans regarding your interest and expected use of acupuncture

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*

Standard Course Tuition: $14,000 by credit card, $13,850 by e-check/check$500 late enrollment fee after January 28.Full-time Resident or Fellow rate (self-pay): $12,500 by credit card, $12,350 by e-check/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 January 28.

Indicate method of payment:*

ACH (e-check)Preferred - HMI Staff will send an e-check 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 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 ($210 + tax per night). 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.