Instrument Sharpening
Certification Course for Dental Hygienists & Assistants
Registration Form - 2 CE Hours
Certification Course for Dental Hygienists & Assistants
Registration Form - 2 CE Hours
Registration Form: Please print and complete this registration form and return it with a current copy of CPR card and tuition by to:
Instrument Sharpening Course for the Dental Hygienists & Assistants
Professional Dental Continuing Education-Del Mar College
104 Village Path
Castroville, TX 78009
For more information call or text: 210-218-8730 or email: prodentalce@gmail.com
*Please use one form per person (photocopy form as needed)
Name ________________________________________________ Credentials (i.e.: CDA) _______________
Date of Birth__________________________________________
(c/o) Dr. _________________________________________________________________________________
Office Address & Suite NO. ______________________________________________________________________
City, State, Zip _____________________________________________________________________________
Office Phone ( ) ___________________________________________Office fax___________________________
Home Address _____________________________________________________________________________
City, State, Zip _____________________________________________________________________________
Home Phone ( ) ____________________________________________________________________________
E-Mail Address: ____________________________________________________________________________
Enclosed $65 (payment to Professional Continuing Ed): Amount: $__________
Full refund of tuition will be honored if cancellation is provided 3 weeks prior to the course.
No refund of tuition fee will be honored for cancellations after the 3 week time.