Academy for Five Element Acupuncture

4 FL CEUs and/or NCCAOM PDAs to licensed acupuncturists

Qty

Description

Amount

Total

Academy Alumni & Faculty

$175.00

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General Public

$200.00

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Total: $0.00

Academy Graduate?

Class number:

Licensed Acupuncturist?

State and License Number

This will help us process your PDAs or FL CEUs quickly. Example: FL AP1111

Payer Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

E-mail: *

Please use your NCCAOM PDA portal email address, if you have one.

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *