Acupuncture Program Balance

$7,900.00

Applicant Information

Full Name * Degree * Street Address *

City *

State *

Zip *

Work Phone Cell Phone * Email * Emergency Contact Name * Emergency Contact Phone *

Program Details & Waiver

Preferred Program Start Date * How did you hear about us?

Waiver & Disclaimer

All applicants must read and acknowledge the Waiver & Disclaimer for Licensed Non-Veterinary Professionals before enrolling.

I have read and acknowledge the Waiver & Disclaimer. *

Technical Requirements

You must have a high-speed internet connection, a computer with a camera and microphone for online components of the program.

I confirm I meet the technical requirements above. *

Payment Method *

Credit Card (pay now online) Check by Mail

Mail check payable to:
Healing Oasis Wellness Center
2555 Wisconsin St., Sturtevant, WI 53177-8100

Your enrollment will remain pending until payment is received.

Note: A 3.5% surcharge applies to all credit card transactions.

Signature & Agreement

By signing below, the applicant acknowledges that they are a licensed health care professional with a current, valid license in the state of residency.

The applicant also acknowledges that:

The Healing Oasis Wellness Center reserves the right to adjust faculty, location, dates, times, and tuition to accommodate unanticipated occurrences.
HOWC is not responsible for any cost/expenses incurred by registrants due to program adjustments or cancellations.
Required documents must be submitted via USPS to complete enrollment.

Signature *

I confirm all information is accurate and I agree to the terms above. *

Applicant

Details

Sign