| Essentials
of Chinese Herbal Medicine
APPLICATION
FORM
COMPLETE
& PRINT THIS FORM |
| I.
Select course format:
Entire course, $900 |
Per tape or disk, ordered by topic, $50 each |
|
II. Select media format:
VHS cassette |
DVD disc
|
|
III. Select tapes if ordering by topic:
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|
Introduction to Chinese Herbal Medicines (Tape 1)
required unless already viewed |
|
Classical Diagnostic Frameworks in Chinese Medicine
(Tapes 2, 3, & 4) required unless already viewed |
|
Herbs and Five Phases (Tape 5) |
|
Herbs and Body Constituents (Tape 6) |
|
Common Zang Fu Syndromes (Tapes 7 & 8) |
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Acute Wind Invasion (Tapes 9 & 10) |
|
Allergies and Asthma (Tape 11) |
|
Herbal Formulae for Pain (includes Headaches) (Tapes
12 & 13) |
|
Digestive Disturbances (Tape 14) |
|
Gynecology (Tapes 15, 16, & 17) |
|
Digestive Disturbances (Tape 14) |
|
Shen States in Herbal Medicine (includes Hypertension
and Sleep Disturbances) (Tapes 18, 19, & 20) |
| Total
Tapes
@ $50 per tape. |
| |
| IV.
Your Information |
|
Name:
|
(First,
Middle, Last)
|
Title: |
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|
e-mail
Address: |
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Mailing Address:
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(Street Address Only, No P.O. Boxes)
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Daytime
Phone: |
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Home
Phone: |
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| City:
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Fax
Number: |
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| State:
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Zip:
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Acupuncture
Training: |
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Year
Completed: |
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CME
Credits earned: |
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Medical
Specialty: |
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| V.
Viewing Partner ($500 extra):
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|
Name:
|
(First,
Middle, Last)
|
Title: |
|
|
e-mail
Address: |
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|
Mailing Address:
|
(Street Address Only, No P.O. Boxes)
|
Daytime
Phone: |
|
|
Home
Phone: |
|
| City:
|
|
Fax
Number: |
|
| State:
|
Zip:
|
|
|
Acupuncture
Training: |
|
|
Year
Completed: |
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CME
Credits earned: |
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|
Medical
Specialty: |
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| VI.
Total Fees: Indicate total course fee
or per tape fees, plus viewing partner fee as
applicable |
| TOTAL
$
|
|
Check enclosed, payable to MAVL,
or: |
Charge
Card
Number:
-
-
-
Expiration Date:
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| Authorizing
Signature: ____________________________ Date:__________________
|
