Extraction 2020 Form - Australian Institute of Advanced Dentistry

EXTRACT ED121

Extraction of Difficult 3rd Molar Teach

Registration Form - ExtractED121

Please complete the fields below:

Name:
(as you would like it to appear on your certificate)

Practice:

Practice Address:

Practice Suburb:

Practice Post Code:

Telephone Number: (including area code)

Mobile Number:

Email Address:

How did you hear about the courses?

Please attach the following with your application (Scanned copies only):

A passport size photograph
Copy of passport bio page
Current AHPRA registration (working in Australian or New Zealand)
Registration to work certificate (not working in Australian or New Zealand)
BDS Certificate or equivalent
Current Resume
2 Referees

Name:

Email Address:

Name:

Email Address:

Please ensure that your passport is current with at least six (6) months validity remaining on either side of your expected course departure and return dates

Do you have any underlying health condition we need to know about?

NoYesIf yes, what?

Is there any medication we need to be aware of?

NoYesIf yes, what?

Package Options

Course

Early Bird Course Only Fee*

Course Only Fee

Surgical Extraction for the General Dentist

$8,160

$8,690

All fees are in AUD$
* Early Bird 3 months price prior to the course date – 30% deposit paid at the time of registration with the balance due on 3 months prior to the course date.
Less than 3 months prior to the course date, full payment is required on registration.

Please indicate one of the following to confirm your registration:

✓

Course Date

Course

Deposit (At time of Registration)

Balance (Less than 3/12)

Full Fee (More than 3/12)

checked

April 2020

Surgical Extraction for the General Dentist

$ $ $

checked

August 2020

Surgical Extraction for General Dentist

$ $ $

Payment terms and Cancellation Policy

Deposit of AUD$ 30% of the fee to reserve your spot. The full fee is to be paid 90 days before the course start date.
Cancellation fee 30 days or more from course start date is 50% of course fee refunded.
Cancellation less than 30 days from course start date will incur no refund