Registration - Competitive Edge Dental Assisting

CLASS*
- ASSISTING COURSE
- CORONAL POLISHING
- SEALANTS
- NITROUS
(circle all that apply):
Coronal Polishing: Two day course with 14 CEs and must have current Tennessee RDA license ($295.00)
One day course with 6 CEs and must have current Tennessee RDA license ($245.00)
One day course with 5 CEs, must have a current Tennessee RDA license ($115.00)
Contact Info
Legal first and last name*
First Last
What name do you prefer to go by?
First
Email*
Phone*
DOB*
MM slash DD slash YYYY
Address*
Street Address Unit City State / Province / Region ZIP / Postal Code
Do you have a current US issued photo ID?*
- Driver’s License
- Passport
Select One
Tennessee RDA#
Choose Your Course.*
Payment Method*
- Credit/Debit
- Check
Total
$0.00

Credit Card*

Cardholder Name

Card Details

Contact Info