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Application Form 3-­‐day comprehensive  training  course  in     Inhalation  Sedation     Dr. Richard Charon BDS (VU Manc.1975) Accredited  by  IACSD     (Intercollegiate  Advisory  Committee  for  Sedation  in  Dentistry  -­‐  April  2015)  

Leading to  a  Certificate  of  Competency     in  Inhalation  Sedation   Jan  2016  onwards   Day  1  Theory  and  Practical  Demonstrations   Days  2  &  3  Work-­‐Based  Assessments   Venue:    

 Regency  Park  Hotel,  Bowling  Green  Rd,  Thatcham,  Berks  RG18  3BY  

Date:  

Name  :  ...............................................................................................................................     Qualifications:  …………………………………………………………………………………………………………….   GDC  Registration  Number  ....................................................................


Practice Name  .................................................................... Practice  Address  ....................................................................

.................................................................... .................................................................... Post Code  .......................................Tel: ........................... email:.......................................

Please enter additional places requested. Please book  a  place(s)  for  my  dental  hygienist(s)/Therapist(s)  ................     Please  book  a  place(s)  for  my  registered  Dental  Nurse(s)  ................                


Course fees:   Should  be  made  by  direct  (online)  bank  transfer  *BACS  please. Including  lunch,  refreshments,  handouts,  Workbook,  resources,  vCPD  and       Competency  certificates  and  mentor  contact  for  12  months.  

£2285.00 per  GDP,  Hygienist  or  Therapist  Total  =    £...............     £208.00  per  Dental  Nurse  vCPD  learning  –  Attendance  certificate   BUT  this  is  not  a  certificate  in  Dental  Nurse  Sedation  available   via  NEBDN  only.    

               Total  =    £...............  

50% of  the  full  fee  must  be  made  2  months  in  advance  for  this  full  course   to  secure  places.    The  balance  to  be  paid  in  full  2  weeks  before  the  first  of   the  2  days  of  Work-­‐based  Assessment  to  be  booked  at  your  practice/clinic  

BACS PAYMENTS  DETAILS   A/C  No:  21549834:            Sort  Code:  56-­‐00-­‐03     International  inter-­‐bank  transfers:     IBAN:  GB76NWBK56000321549834   BIC:  NWBKGB2L  

If needed:  Account  Name:  Richard  Charon  

NB: PLEASE  ENTER  YOUR  OWN  NAME  AS  THE  REFERENCE  SO  WE  CAN   TRACE  WHO  HAS  MADE  THE  PAYMENT.  THANK  YOU. Please  e-­‐mail:  richard@the-­‐ra-­‐coach.co.uk                Mobile:  07884  230995:                       Web:  www.the-­‐ra-­‐coach.co.uk  Blog  www.theracoach.blogspot.com  

Inhalation Sedation Course Application Form  

This is an IACSD Accredited 3 day course. Days 2 & 3 are Work-Based Assessments carried out at your own clinic/practice.

Inhalation Sedation Course Application Form  

This is an IACSD Accredited 3 day course. Days 2 & 3 are Work-Based Assessments carried out at your own clinic/practice.

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