Please copy the application form in email and contact us for more info.

Tel. +1 604-518-6455

info@vancouvertcm.ca

OMAlogohttp://www.orientalmedicine.ca

Oriental Medicine Academy Course

Application Form:

1. PERSONAL INFORMATION

Legal Name:  ________Last (Family) __________First Middle

Application / Registration Number: __________________ (office use only)

Date of Birth _______ / ________ / ________Month/ Day/ Year

2. CONTACT INFORMATION

Details Home Address (For Office Record Only)

_______________________________________________________________________

_______________________________________________________________________

Tel.(      )_________ Fax. (        )________ Email_________________________

3. COURSE INFORMATION

The course is scheduled as

From ___day/____month/_____year        till ___day/____month/_____year

Note: Please set up the schedule before application.

Content:

Please check details as posted on the website: http://www.orientalmedicine.ca

4. Tuition:

Price: CAD $______ (incl. tax)

Signature:

Applicant (print name):

Date:

Terms and Conditions

1. Weekend course is only available to applicants who are able to devote full-time attendance during the course as scheduled;

2. Only cash, certified cheque or e-transfer (for Canadian) is acceptable and can be issued at the starting of course:

3. Duplication content of course notes to others in any manner is strictly prohibited;

4. No refund or exchange after the course material is sent out.

Please send the application back no later than 1 week before the scheduled course.

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