CHINATOWN WELLNESS CENTER

 

presents the

CHINESE HERBAL MEDICINE PROGRAM (Year 2)

REGISTRATION FORM
PLEASE PRINT CLEARLY


NAME _____________________________________________________________________

ADDRESS __________________________________________________________________

CITY/STATE ____________________________________         ZIP ___________________

TELEPHONE (HOME) ______________________         (OFFICE) ______________________

EMAIL ADDRESS (OPTIONAL) _________________________________________________

ACUPUNCTURE LICENSE NO. __________________________________________________

DATE OF GRADUATION FROM ACUPUNCTURE SCHOOL _______________________

SCHOOL OF ACUPUNCTURE GRADUATED FROM: __________________________________

Please check one

    One payment of $2,500 a year paid in full before December 17, 2007.

     Two payments of $1,400 a year
          (1st payment before December 17, 2007 & 2nd payment by May 10, 2008).

**NOTE: After December 17, 2007 the new payment will be $2,750.
     And for the Two payment option after December 17, 2007, the 1st payment will be $1,600.

Make checks payable to

Chinatown Wellness Center, LLC
52 Walker St. 2nd Floor
New York, NY 10013
(212) 966-8830
www.cwcherbs.com

Register Early to ensure your enrollment as class will be limited.


No audiotaping or videotaping of class will be permitted.