Medical Acupuncture for Physicians
AC62 Application

Tempe Mission Palms Hotel, Tempe, AZ
Introductory Weekend: 30 November - 4 December 2017
Clinical 1: 16 - 20 February 2018
Clinical 2: 23 - 27 May 2018

In addition to completing this form, the following documents are required for your application to be considered. You must submit them via email to mafp@hmieducation.com:

The fields indicated with an asterisk (*) are required.

Name and Professional Information
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Sex:*
Date of birth:* / /
mm / dd / yyyy

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Contact Information
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A personal email address is preferred. Military personnel and government employees must list a non-work email address for their primary email.
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Home address:

For shipping course materials.

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Street address only, no P.O. boxes.
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Please use the format 555-555-555 for US phone numbers.
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Please use the format 555-555-5555 for US phone numbers.
Military Personnel & Government Employee Applicants Only
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Date of end of obligated service: /
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Pathway*
Tuition*
  • ($11,500 after 31 Oct. 2017)
  • ($9,500 after 31 Oct. 2017)
    Applicant must be a full-time resident or fellow through the conclusion of the course and pay his/her own tuition.

Indicate method of payment:*

  • (preferred), payable to Helms Medical Institute, 2520 Milvia Street, Berkeley, CA 94704
  • , call 510-649-8488 between 8:30 AM and 12:30 PM Pacific Time
  • , fax to 510-649-8692
  • , HMI Marketplace on Square
  • , specify:
Supplemental Materials

The following documents are required to process your application:

  • Résumé / CV
  • Photocopy or scan of your current medical license
  • Statement of plans (Military applicants: In your statement, please confirm your base command's endorsement of your training and an acupuncture-friendly clinical setting.)
  • Tuition payment (unless the tuition is funded through a 3rd party)

Your personal check will not be deposited until you have been accepted to the course.

Your credit card will not be charged until you have been accepted to the course if you call or fax.

Once you have submitted this online application you will receive a confirmation email. Reply to this email with the above documents as attachments.

All training activities will take place at Tempe Mission Palms, Tempe, AZ. You are requested to lodge at the hotel where a group rate has been arranged. A conference day use fee of $75 per day is required of participants who choose to stay elsewhere or room with another course participant. For additional information about this course, call 510-649-8488 or e-mail mafp@hmieducation.com.