Bitte im Fall einer Anmeldung ausfüllen und faxen an:
07422 21699 oder 25519 – http://www.akupunktura.de
APPLICATION FORM FOR BEIJING INTERNATIONAL
ACUPUNCTURE TRAINING CENTER
Õ D /
Family name
First name
Name in Chinese (if applicable) :________________________
Title
Sex
Nationality
Chinese descent : Yes No
Religion
% Ù
Date of birth / Year
Month
Day
Passport No.
+
Visa number
:__________
The expiry date of passport
+ %': ____ (year) ___ (month) ___ (day)
The expiry date of visa
%': ________(year) ______(month)________(day)
ID number (Korean Participants only)
Ú (
): ___________________
City for Applying for Visa ü
ü
Number of entrance %
%
%
%:___________Number of entourage %
%
%
%:_________
Tel. No. /
Fax No. 1
Cell phone number in China (if applicable)"' :_________________________
E-mail /
Family relation
child of diplomat
Yes
No
child of governmental official
Yes
No
Source of tuition
: self-supported
government
Photo
2pieces

- 2 -
Permanent residence address
Temporary residence address in China
Profession 4 Medical Doctor / Acupuncturist
Nurse
Anesthetist
Medical Student D /
D /
D /
D / Physiotherapist
Other
Degree
Languages Known to Applicant
Course Time and Title Selected
ü
Study Experience at CBIATC CBIATC
______________________________
Arrival details : date:
time:
flight number:
Departure details
: date:
time:
flight number:
Date of Application / '
'
/ '
'
Signature