Board Certification Affidavit
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ABMA Board of Trustees
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Please print out this form, sign it, and mail it with the application


I, _________________________________________________________

hereby affirm that I have practiced a minimum of two years in clinical medical acupuncture since completion of my formal, basic medical acupuncture training (a 200 hour training program).
I further affirm that I have completed at least 500 medical acupuncture treatments. My medical acupuncture practice involves more than one of the following acupuncture paradigms including, but not limited to, energetic acupuncture, neuroanatomic acupuncture, 5 Elements, TCM, Auricular, Scalp, Hand, etc.

Signature ____________________________________

Date ____________________

American Board of Medical Acupuncture
1970 E Grand Ave, Suite 330
El Segundo, CA 90245
(310) 364-0193 | (310) 364-0196 fax