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MIAMI, USA
RITZ CARLTON

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DR . PAUL LAM’S APPLICATION FORM FOR TAI CHI FOR HEALTH INSTRUCTOR / LEADER'S CERTIFICATE
TAI CHI for Arthritis© , TAI CHI for Diabetes© & TAI CHI for Osteoporosis© pro

	I, declare that I am a:
	TAI CHI teacher
	Advanced TAI CHI Student
	of year/s.
	Physiotherapist or Physical Therapist
	Occupational Therapist
	Health Practitioner, my field of expertise is

	I have enclosed a copy of my qualification questionnaire. Below is a brief outline of my experience in my field. (Please include experience working with older people, people with arthritis and experience in exercise instruction):

	My qualifications are (e.g. accreditation, degree, TAI CHI teacher, etc):

	I declare to the best of my knowledge the above statement is true. I agree that I must have a current CPR certification, a current accredited first aid course, or similar qualification (e.g. RN or MBBS before teaching this program). I wish to apply for an Instructor’s Certificate but am prepared to accept an Attendance Certificate if Dr Lam or his authorized master trainer consider that by the end of this course I am not yet ready. I also understand that the instructor's certificate will need to be updated once every two years.
	Name:
	Date:	/ / - dd/mm/yy
	Email: