Chinese Scalp Acupuncture
Application

Edward Hotel Chicago, Rosemont, IL
23 August 2019

Note: This course is currently full. Please complete an application to be put on the waitlist.
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.