Missouri Basic Skills Review Course

Questions? Please contact Mandy Lewis at mandy@modentalmail.org.

Primary Registrant

Registration Category *

First Name *

Last Name *

Home Address *

City *

State *

Zip *

Cell Phone *

Email *

Supervising Doctor Name *

How long have you been a dental assistant? *

Have you already attempted the Basic Skills Exam? *

What course date/location are you registering for? *

Additional Information

Cardholder first name *

Cardholder last name *

Billing address *

Billing city *

Billing state *

Billing zip *

By checking this box, you agree to the course cancellation policy (below).

Cancellation Policy: A $25 fee per registrant will be charged for all cancellations made more than 2 weeks from the course date. No refunds will be made less than 2 weeks prior to the course date. If you must cancel after that date, you may reschedule for the next available course date or transfer registration to another person. No refund or transfer will be provided to any registrant who does not show up to the scheduled review course without prior notification of the MDA. Questions? Please contact Mandy Lewis at mandy@modentalmail.org. *

Payment Amount: $0.00