2712 San Gabriel Boulevard, Rosemead, CA 91770 USA

Telephone: 626-288-1199; Fax: 626-288-4199; E-mail: sotcm@sotcm.com; Website: www.sotcm.com

Continuing Education Courses Registration Form (Please fill out this form, and click "Send", it will send to sotcm@sotcm.com)

How to register: Please fill out this form & send it to us. Class sizes are limited and early registration may assure your place in a high demand class. Classes that do not meet minimum participant enrollment may be cancelled. Your timely registration may help ensure this necessary enrollment figure.

Deadlines for registration: The registration deadline is the start of each course. We urge you to register at least one day prior to our courses; however, registering on the day of class is acceptable.

Cancellation policy: You can cancel a course before the course begins.

How deposits are handled: We request that you make a deposit to reserve seats because seats are limited.

How refunds are handled: If you have made a deposit, only 80% will be refunded if you cannot attend the courses with any reason.

Participant Information:

Your first name(Given):

Your last name(Surname):

Your license #:

Your NCBTMB #:

Your Employer:

Gender
Male
Female

Your Work Address:

City:

State or Province:

Zip Code or Post Code:

Country:

Your Home Address:

City:

State or Province:

Zip Code or Post Code:

Country:

Email:

Your Work Telephone:

Your Home Telephone:

Fax:

Prerequisites: Licensed / Registered massage therapist / technician.

NCBTMB Statement: America¡¦s Institute of Traditional Medicine is approved by the National Certification Board for therapeutic Massage and Bodywork (NCBTMB) as a continuing education Approved Provider.

Course Location(s): 2712 San Gabriel Boulevard, Rosemead, CA 91770 USA

Following course offering(s) are offered for NCBTMB continuing education hours. Please check the subject areas that you are interested in and will be available to attend: (Please check all that apply)

Course Ordered # 1:
Recent Trend of Massage Therapy Techniques (6 Hours, Approved by both NCBTMB & BPPVE, CA). (Please Indicate Course Date and Time, Also Indicate Live Seminar or Web Course):

Course Ordered # 2:
Updated Regulations and Policies in the Massage Therapy Field (6 Hours, Approved by both NCBTMB & BPPVE, CA). (Please Indicate Course Date and Time, Also Indicate Live Seminar or Web Course):

Course Ordered # 3:
Recent Progress of Scientific Research for Massage Therapy (6 Hours, Approved by both NCBTMB & BPPVE, CA). (Please Indicate Course Date and Time, Also Indicate Live Seminar or Web Course):

Course Ordered # 4:
Literature Review of Massage Therapy (6 Hours, Approved by both NCBTMB & BPPVE, CA). (Please Indicate Course Date and Time, Also Indicate Live Seminar or Web Course):

Course Ordered # 5:
Basic Knowledge of Chinese Herbal Media for Massage (6 Hours, Approved by both NCBTMB & BPPVE, CA). (Please Indicate Course Date and Time, Also Indicate Live Seminar or Web Course):

Course Ordered # 6:
Qi-gong Exercise (6 Hours, Approved by both NCBTMB & BPPVE, CA). (Please Indicate Course Date and Time, Also Indicate Live Seminar or Web Course):

Course Ordered # 7:
Tai-ji Quan Exercise (6 Hours, Approved by both NCBTMB & BPPVE, CA). (Please Indicate Course Date and Time, Also Indicate Live Seminar or Web Course):

Course Ordered # 8:
Case Studies (8 Hours, Approved by both NCBTMB & BPPVE, CA). (Please Indicate Course Date and Time, Also Indicate Live Seminar or Web Course):

Course Ordered # 9:
Ethics (6 Hours, Approved by both NCBTMB & BPPVE, CA). (Please Indicate Course Date and Time, Also Indicate Live Seminar or Web Course):

Course Ordered # 10:
Dietary Supplements (6 Hours, Approved by BPPVE, CA). (Please Indicate Course Date and Time, Also Indicate Live Seminar or Web Course):

Cost of the course offering(s): U.S. Dollars 10.00 per hour. (Payable to ¡§America¡¦s Institute of Traditional Medicine¡¨)Total:

Registration Fee:

Grand Total:

Payment made by (please indicate one: Personal check & check #; Business check & check #; Credit Card:

We accept Visa, MasterCard, Discover and American Express. Your credit card statement will show a charge to ¡§Academic Medical Center, Inc¡¨. If paid by credit card, please select one of credit card:
Visa
MasterCard
Discover
American Exprsess

Credit Card information:
Name on Credit Card:

Credit Card Number:

Card Verification Number(CVN) (It is an anti-fraud security feature to help verify that your card is in your possession. For Visa/Mastercard/Discover, locate the three-digit CVN number printed on the signature panel, back of card, far right. For American Express, the four digit CVN number is imprinted on the front, right, above the account number):

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