TCVM Annual Conference

Step 1 - Attendee Information (please submit a separate form for each attendee if your family and/or friend come with you for the conference or post-conference tour)

First Name:

Middle Name:

Last Name:

Nick Name:

Title:

License Number:

Gender:
Female
Male

Dietary preference:
Regular
Vegetarian

Specialty:
Small Animal
Equine
Exotic

Email Address:

Confirm Email:

The above email address will be used by the Chi Institute to communicate with you. Please make sure you add emails from @tcvm.com as safe senders in your email account to ensure that you receive important course information.

Step 2 - Contact Information

Home Address Line 1:

Home Address Line 2:

Home City:

Home State:

Home Zip Code:

Home Country:

Home Phone:

Business Address:
Same as the Home Address

Online TCVM Practitioner Directory Listing for Client Search (free service):
Yes, list my business contact information.
No, I do NOT want to be listed.

Business Address Line 1:

Business Address Line 2:

Business City:

Business State:

Busi. Zip Code:

Business Country:

Work Phone:

Fax Number:

Your Web Site URL:

Business Email Address:

Step 3 - Conference Session to Register

20th Annual TCVM Conference 2018

AATCVM and WATCVM active members (during the time of the conference) will receive 5% additional discount.
Participant must register for conference lectures in order to register for any Workshops.

Small Animal Lecture Track On-site (Nov. 1-2, 2018): $350.
Equine Lecture Track On-site (Nov. 1-2, 2018): $350.
Workshop: How to Boost Financial Qi in Private Practice On-site (Nov. 3-4, 2018): $150
Workshop: Food Therapy Nutritional Balance (Nov. 3-4, 2018): $250
Workshop: Acupoint Scanning/Lameness Diagnosis in Horses (Nov. 3-4, 2018): $250
Workshop: Integrative Therapies for Canine Neurological Diseases (Nov. 3-4, 2018): $250
Workshop: How to Create a Customized Herbal Recipe (Nov. 3-4, 2018): $250
Discount for Registering for Both Lecture Tracks On-site (Nov. 1-2, 2018): $-150.
Discount for Registering for Both Lecture Tracks and All 5 Workshops (Nov. 1-4, 2018): $-500
Application Fee (for new student only, nonrefundable and due upon registration): $100.
I am an active WATCVM Member and would like to receive a 5% Discount

Additional Fee: $0

Total Tuition Amount Due: $

Send Class Materials To:

Step 4 - Payment Information

Pay by Credit Card (Recommended) - your credit card information is secured by HTTPS encryption

Please charge the following credit card now for $:

(If you choose NOT to pay the entire balance of the tuition upon the registration, you agree that the Chi Institute charges the tuition balance on this credit card for your convenience 60 days before the start of the conference unless you notify us otherwise in advance.)

Card Type:

Credit Card Number:

Exp.Month:

Exp.Year:

CSC Code:

Credit Card Billing Information:

Billing is same as Home Address

Billing is same as Business Address

Card First Name:

Card Last Name:

Billing Street Address:

Billing Address Line 2:

Billing City:

Billing State:

Billing Zip Code:

Billing Country:

I want to pay by other means (not paying by credit card)**:
Pay by Check or Money Order
Pay by Bank Wire Transfer (please send me Chi Institute Taiwan bank account information)

** If you choose not to pay by credit card, we can NOT guarantee your seat until your payment is received by us. ALL checks must be drawn on USA Banks - US Dollars Only. Please make the check payable to: Chi Institute of Chinese Medicine. Please include your name & program of study on the memo line if paying by a company check.

Step 5 - Answer the Questions

How did you hear about this program:
Friends
Conference
Magazine
Internet
Mailer
Email

If you have studied veterinary acupuncture or herbal medicine before, please enter your history below:

If you are a new Chi student, please input your Brief Bio below. (Please include the CVM you graduated and in which year, your goals in studying TCVM and some personal information about your interests):

If you are a new Chi student, please email a recent passport style photograph of yourself to register@tcvm.com.

Step 6 - Comment, Sign and Submit the Registration Form

Comment or Memo to the Chi Institute Student Administration Office:

I Agree to the TERMS AND CONDITIONS FOR THE CHI INSTITUTE OF CHINESE MEDICINE, Inc.

by Signing My Full Name Below.