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Instructor and Healing Certification Application

Kindly fill out the Certification form below for Tai Chi Instructor, Qigong Instructor or Qigong Healing. After the form is reviewed a staff member will contact you.

Tai Chi and Qigong Instructor or Healing Certification Application

First name*

Last Name*



Zip Code


Home Phone Number

Cell Phone Number

Fax Number

Email Address*


Present Occupation

Professional Training, Certifications and Educational History

Meditation, Martial and Healing Arts Experience

Why do you desire to become a Tai Chi or Qigong Instructor or a Qigong Healing Practitioner?

This is all the information we need at this moment. Thank you!

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