APPLICATION for Competitive Edge Dental Assisting Academy, LLC CLASS* ASSISTING COURSE CORONAL POLISHING SEALANTS NITROUS (circle all that apply): Choose Assisting Course Start Date:* June 6, 2024 Select OneCoronal 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 InfoLegal 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 OneTennessee RDA# Choose Your Course.*ASSISTING COURSE APPLICATION FEE (NON-Refundable) - $100DO NOT USE - TEST ONLYTotal $0.00 PhoneThis field is for validation purposes and should be left unchanged. Δ