Name:

Address:

Zip-code:

City:

Country:

Phone number:

Date of birth:

Passportnumber:

E-mail:

⃞ Yes, I would like to subscribe to the bachelorsprogram (2 years, 6 modules per year, electives excl, €300,-- per module, for discount see particitation statement)

⃞ Yes, I would like to subscribe to the mastersprogram (2 years, 4-8 modules per year, electives excl, €300,-- per module, for discount see particitation statement) (bachelorsprogram or comparable level of experience and knowledge required).

Specialisation:

⃞ Acupuncture and Tuina massage (8 modules per year, electives excl)

⃞ Qigong healing (8 modules per year, electives excl)

⃞ Psychotherapy (8 modules per year, electives excl)

⃞ Taiji (8 modules per year, electives excl)

⃞ Qigong teacher (8 modules per year, electives excl)

⃞ Yi Jing studies (4 modules per year, electives excl)

⃞ Daoist philosophy and religion (4 modules per year, electives excl)

⃞ Comparative studies Western and Chinese medicine (8 modules per year,electives excl)

⃞ Comparative studies Western and Chinese Psychology (8 modules per year,electives excl)

⃞ No, I do not wish to subscribe to a BA/MA program, but I want to attend the following modules (€400,-- per module):

⃞ Zhongwujigong I, Jing Construction training

⃞ Basic Theories I: Yin Yang theory, Wuxing Theory, Yi JIng

⃞ History: China, Qi Gong, Chinese Medicine

⃞ Zhongwujigong II*, Qi and Shen, function and awareness

⃞ Chinese Anatomy and Fysiology*: Bodyfluids, Qicirculations, Organ anatomy

⃞ Chines medical Pathology*

⃞ Tuina Massage/Acupuncture*

⃞ Qigong healing*: body-mind correction/qi field correction/ ritual healing

⃞ Daoïst Psychology*

⃞ Buddhist Psychology*

⃞ Confucianist Psychology*

*: Previous studies and assessment required. In all cases an intake-interview is required.

⃞ I would like to subscribe to one the following elective modules/ postgraduate courses

⃞ Wudang Fitness Instructor

⃞ Colour Breathing and swallowing

⃞ Daoist Psychology, foundational (communication qigong)*

⃞ Tuina Massage/Acupuncture*

⃞ Qigong healing*: body-mind correction/qi field correction/ ritual healing

⃞ Daoïst Psychology*

⃞ Buddhist Psychology*

⃞ Confucianist Psychology*

⃞ Reading and understanding classic Chinese texts

⃞ Course Chinese Language

*: Previous studies and assessment required. In all cases an intake-interview is required.

My experience in the field of study I have chosen is:

Previous schooling/educational level:

My motivation to study at the Oriental College is:

How did you find the Oriental College:

I would like to pariticipate in organising a local studyclass in ....................................................
(for students from abroad) (in exchange for a discount of 40%)

Participation Statement:

I hereby declare that I participate freely in the course and do not hold only myself responsible for damage due to wrong use of the material under study. I hereby recognize the authority of the school to judge as such is the case. I also recognize that failing to comply with the standards that the school sets for graduating I can not make claim to have studied at the OC or with the teachers and that I will not try to make a living based on the participation with OC classes without written permission (that is our quality guarantee), nor that I will use the material under study by any means available to me without OC consent. I recognize the sovereign rights of the school on all it’s offered materials. Materials and ideas that I produce during the program are co-owned by the school and me. Use will always be negotiated between us. I also understand that apprenticeship and participation in professional development projects are essential parts of my learning obligations. Basically I declare that I will perform to the best of my ability.

I agree that I pay my tutoring fees:
⃞ per module
⃞ per month
⃞ per year
⃞per two years (per two years: discount € 150,--).

I agree that if I want to unsubscribe from a program I have to pay for the ongoing year.
⃞ Yes
⃞ No

I will pay the tutoring fees by money cheque / cash / depositing on NL Giro 7535194 from the Yin Yang Centrum or at Triodos Bank account 212172638. By international payment transfercosts are my responsibility.

(Please mention IQA- year of subscription-phone nr- payment sequence / module name)

Payments have to be done before the course starts if paying at once or at the beginning of each month during the year at which the course is followed. In case payment is overdue € 10,-- a month will be added.