Registration

APPLICATION for Competitive Edge Dental Assisting Academy, LLC

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CLASS*

ASSISTING COURSE

CORONAL POLISHING

SEALANTS

NITROUS

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Choose Assisting Course Start Date:

January 23, 2024

Select One

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)

Legal first and last name*

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Email*

Phone*

DOB*

Address*

Street Address Unit City State / Province / Region ZIP / Postal Code

Do you have a current US issued photo ID?*

Driver’s License

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Tennessee RDA#*

Choose Your Course.*

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