Kiiko Matsumoto's Japan Study Seminar - December 2019 Application

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Before applying, please be sure to read all about the seminar, our application process, eligibility and cancellation policy at our website: http://yuyaosociety.com/japan-study-seminar.html

Email *

Re-enter Email *

Personal Information

Last Name *

First Name *

Street Address *

Town/City *

State/Province *

Postal code *

Country *

Age

Gender

Phone number *

Emergency Contact name and phone *

Medical conditions or allergies

Bento lunch option *

Lunch is included in your tuition, however, we cannot accommodate specific dietary needs. If you have allergies there are many other options nearby for purchasing lunch.

Yes - regular

Yes - vegetarian

No thanks, I will buy my own lunches out.

PROFESSIONAL INFORMATION

Acupuncture background *

What style(s) of acupuncture do you practice? Have you studied/do you practice Kiiko Matsumoto Style or another Japanese style, and if so where and for how long? Please describe your experience below and why you would like to join us in Japan. PLEASE BE DETAILED!

Type of medical credential (LAc, MD etc) *

License number and issuing body

Acupuncture school/program and year of completion *

Years of practicing acupuncture *

Currently practicing? *

Yes

Trip Deposit

Choose from these options below:

Choice 1: Mail a check made out to "Yuyao Society LLC" for the US $150 deposit to:

Yuyao Society
Attn. Kiiko Japan Trip
30 Garden Alley
Doylestown, PA 18901 USA

*Your check will only be deposited if you are accepted to the seminar.*

Choice 2: Receive an online invoice for $150, which can be paid by credit card or Paypal. The remaining balance of $550 will be invoiced later and is due by August 1st. (There is approximately a 3% fee added to online transactions in the USA, approximately 4.5% if you’re outside of the USA.) You will be invoiced ONLY if you are accepted to the trip.

IMPORTANT: If the deposit is not received after one week of being accepted to the seminar, your place will be offered to another candidate. The deposit is non-refundable. We appreciate your commitment and sincerity in reserving a space in our life-changing seminar.

Deposit type *

Check: I will mail a check as instructed above

Online payment: Send me an invoice (credit card/Paypal) to the email provided above

Almost done...

By hitting the "Submit" button below, you acknowledge and agree to our cancellation policies described here: http://yuyaosociety.com/policies.html
Don't forget to click the "Submit" button... and look for a confirmation screen which means we received the application.
Did we mention... BE SURE TO HIT THE "SUBMIT" BUTTON!!!! :) Arigatou Gozaimasu!

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