Registrations are accepted by:

E-mail: drzev@roadrunner.com
Fax: 207-989-0752

Mail: International Academy of Chiropractic Acupuncture, Inc.  291 Main Road, Holden Maine 04429

City Location:____________________________________

Name:__________________________________________

Address:________________________________________

City:______________________State:_________________

Zip Code:________________________________________

E-mail:__________________________________________

Phone Number: (O)_______________________________

(H)______________________(C)_____________________

Module: Basic: (1) (2) (3) (4)

Advanced: (1) (2) (3) (4)

Graduate: (1) (2) (3) (4)

Dr. Fee: $595.00 Per 25 Hour Module

Dr. Refresher Fee: $495.00 Per 25 Hour Module

Staff Fee: 50% of Doctor Fee Per Staff Person

Student Fee: $295.00 Per 25 Hour Module

Workbook Fee: $99.00 Basic 100, $25.00 Advanced 200, $75.00 Graduate 300

Supplies Fee: $40.00 (Advanced 200 Only!)

Testing Fees:

Basic 100- $50.00

Advanced 200- $100.00

Graduate 300- $150.00

THERE IS A $150.00 FEE FOR RETAKES OF FINAL EXAMS 

__________________________________________________

Total Amount:_____________________________________

Credit Card Number:________________________________

(Visa, Master Card, Amex, Discover)

Expiration Date:___________________________________

Signature:________________________________________

Previous Acupuncture Training: (Y)  (N)

Instructor:________________________________________

Amount of Hours Certified:__________________________

_________________________________________________

2009/2010 Cancellation Policy:

• Full refunds will be issued with two weeks notice
• Fifty percent will be issued with one weeks notice
• Refunds will not be issued 6 days prior to seminar
• Refunds will not be issued for late arrivals or inclement weather.
   

Last Updated 2/15/09