Name:
Enter your FULL name (first and last).
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| Address
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| State/Province |
Zip/Postal Code
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| Area
Code and Phone Number |
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| Email
Address |
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Website
Address
(if any) |
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| Tell
us more about you. |
Your
Languages:
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Gender:
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Please
select your profession:
Select all that apply. |
Acupuncturist |
Chinese Medicine Practitioners |
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Acupressure
Practioner |
Tai Chi Master |
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Herbs Practioner |
Qi Gong Master |
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Others, please state:
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Your
Professional Organization:
Please enter the names and positions (if any) of all the
professional associations, clubs and other professional associations you
are a member of. Also enter how long you have been a member in each association,
club or organization. |
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Your
qualifications, work experience
and reference:
Please enter your complete work history, professional accomplishments,
educational background and any other professional references.
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| Years
of Practice: |
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Password:
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Due to the high number of membership requests we receive,
please allow at least 48 hours for new membership processing and verification.
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