Chinese Scalp Acupuncture
Application

Edward Hotel Chicago, Rosemont, IL
23 August 2019

In addition to completing this form, the following items are required for your application to be considered.
  • Scan of your current medical license
  • Tuition payment
The fields indicated with an asterisk (*) are required.
Name And Professional Information



Contact Information

Home Address:





Tuition*

CSA Course Only: $725($800 after August 1) CSA and Graduate Refresher Course: $1700($1900 after August 1)

Indicate method of payment:*

CheckPreferred - Payable to Helms Medical Institute, 2520 Milvia Street, Berkeley, CA 94704 Credit 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 Edward Hotel Chicago (Rosemont, IL) where a group rate of $112 (plus 14% occupancy tax) has been arranged. Reservation information will be provided upon acceptance to the course.

For additional information about this course, call 510-649-8488 or e-mail mafp@hmieducation.com.