Professional Certification Program in Acupuncture and Oriental Medicine
Registration Form
First Name
Last Name
Street Address
City
State
Zip Code
Home Phone
Cell Phone
Email
Date of Birth
Degree and  
Specialty
License Number
How did you hear
about us?
Payment Information
Name on Card
Select Card Type
Card Number
Expiration Date
Security Code CVV
                 Select Payment Option

    Full Certification Course (1-4)
          
1. $ 3,995.00 **Best Value**One Time Payment due by 08-01-2018

2. $ 4,995.00 *Good Value* One Time Payment due by 10-1-2018

3. $ 699.00 per month for (8) Monthly Payments Total: $ 5,592.00
Must register with first payment on or before 08-01-2018

4. $ 799.00 per month for (8) Monthly Payments Total: $ 6,392.00
Must register with first payment on or before
10-01-2018
Select payment Option:
Payment Amount
Option Two
Option Three
Option Four

      Payment and Refund Policy

Payment:
Payment via credit card (Visa, Master Card, Discover or
American Express), cash or checks are accepted. Upon
receipt of your paid tuition, an email confirmation from
Connecticut Acupuncture Certification Program will be
sent to you.

Refund Policy:
Refunds, less an administrative fee of $95.00, will be
issued for all cancellations received by October 1,
2018.  Refund requests must be submitted by US Postal
Certified Mail and must be postmarked by October 1,
2018.  No Refund will be issued should cancellation
occur after October 1, 2018.  "No shows" are subject to
the full course fee and no refunds will be issued once
the program has started.

In the event of an emergency or personal illness, credit
for the program will apply toward future programs.

Tuition and Payment Plan Options for Full
Acupuncture Certification Course


**Best Value** Save with Pre-Registration and  
Payment in full by August 30, 2018
$ 3,995.00


**Good Value** Save with Registration and
Payment in full after August 30
$ 4,995.00


Payment Plan 1: Eight (8) monthly payments
of $699.00 totaling $ 5,592.00

Registration and first payment due by
August 30, 2018


Payment Plan 2: Eight (8) monthly payments of
$799.00 totaling $ 6,392.00 if after August 30,
2018

Registration and first payment due no later than
October 1, 2018
Option One
Payment Options
Disclaimer:  Please note this course
does not meet the requirements in CT
to become a LAC, Licensed
Acupuncturist.
Completing this course does not grant
you the right to designate yourself as a
Licensed Acupuncturist, LAC.  A
Licensed Acupuncturist must complete
a Masters Program in Acupuncture by
an accredited college program and
pass the national board examination
administered by the NCCAOM.