Application for ASA Capitol Hill Health Fair Licensed Acupuncturists or Acu Coordinators

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What We Are Looking For:

· 20 Licensed Acupuncturists willing to be anonymous for the day and commit to two hours of acupuncture treatments in 20 minute increments. Treatments will be given to congressional staff and legislators.

· 5 Experienced Licensed Acupuncturists willing to answer any questions individuals may have about acupuncture throughout the event.

Requirements:

· For Coordinators, we are looking for practitioners who have at least 5 years of experience, and an exceptional ability to convey balanced and accurate information about acupuncture in easy to understand terms.

· For both positions, candidates must:

· Attend ASA Conference

· Be licensed in their state

· Carry malpractice Insurance

· Be a member of an ASA-affiliated State Association (no time frame for membership...we encourage all to join their state association if wanting to take part in this event.)

· Be willing to use their own supplies

· Be willing to adhere to prescribed dress code

· Be willing to adhere to safety protocols

· Agree to NOT promote their own practice or advertise

· Be able to be on your feet for two hours

· Be willing to help set-up/tear-down

Email *

Full Name *

Email *

Address *

Phone *

Seeking Lic Ac position or Coordinator position? *

Licensed Acupuncturist

Coordinator

Either

Are you a licensed acupuncturist (or state equivalent) in your home state? *

Yes

Which ASA State Association Member are you a member of? *

Have you worked in a group environment? *

Yes

Do you agree to abide by the rules of engagement? *

Yes

How long have you been in practice? *

Your Education: What Acupuncture School did you attend? Please state years of attendance. *

Disclaimer & Signature: I certify that my answers are true and complete to the best of my knowledge. I understand there will be an interview with the ASA Conference Committee before decisions are made.If this application leads to being chosen, I understand that I need to provide a copy of my state license and proof of malpractice insurance before day of event. I understand I will bring my own travel kit and use my own supplies and they must be able to get through the sensors in the Rayburn HOB. *

I agree to these conditions.

I disagree to these conditions.

Send me a copy of my responses.

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