CHINATOWN WELLNESS CENTER
CHINESE HERBAL MEDICINE PROGRAM (Year 2)
PLEASE PRINT CLEARLY
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
Register Early to ensure your enrollment as class will be limited.
No audiotaping or videotaping of class will be permitted.