Note: The purpose is:
1. To get enough information about you to verify that you are a teacher of qigong.
2. To let us know what information you want posted on the internet: www.qi.org
1. Name ____________________________________________________________
2. Organization ______________________________________________________
3. Street ____________________________________________________________
4. City _____________________________________________________________
5. State ________ Country_____________________________ Zip _____________
6. Phone _________________________ email _____________________________
7. Type of qigong ____________________________________________________
8. Qualification to teach________________________________________________
_________________________________________________________________
9. Second type of qigong _______________________________________________
10. Qualification of second type __________________________________________
_________________________________________________________________
(if more types, continue on back)
11. What information do you want on the web? (name required)
12. Organization____ (check if want shown)
13. Address ____ (address and/or phone required) (check if want shown)
14. Phone ____ (check if want shown)
15. Type(s) taught (Please list them here exactly as you would like them shown.) _____________________________________________________
_________________________________________________________________
16. Signature __________________________________________Date ___________
(signature indicates you verify statements are true and complete)
17. A link to your page _________________________________________________
(Please make additional comments on back)(Please resubmit yearly so we can keep our list up to date)
Mail to: Qigong Association of America
1220 NW Kings Blvd.
Corvallis, OR 97330