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2019 Application for the Healer's Art FDW Training

2019 Application for the Healer’s Art Faculty Development Training

1. Name and Education History *This question is required.
Medical School where you will teach The Healer's Art *This question is required.
Institution where you will teach The Healer's Art *This question is required.
Professional Position *This question is required.
Professional Position *This question is required.
Professional Position (if more than one held concurrently)
Professional Position (if more than one held concurrently)
4. Work Contact Information *This question is required.
5. Home Contact Information
6. Which is your preferred email? *This question is required.
CME credit for this workshop training will be forthcoming.
CANCELLATION & REFUND POLICY: A deposit of $300 is due at time that your application is accepted. The balance is due by June 15, 2019. A full refund of deposit (less processing fee of $25) will be issued for cancellations on or BEFORE July 1. Cancellations after July 1 will forfeit deposit.