Gingival Composite Characterisation Booking Form

Course places are limited to just 8 delegates per course for a better learning experience and more focused hands-on teaching.

Course Fee: £250 + VAT per person (£300 inc. VAT per person).

Select your preferred date and location

Friday 7 February - OLDHAM
Friday 21 March - LETCHWORTH
Friday 6 June - OLDHAM
Friday 11 July - LETCHWORTH

Name (Lead booker):

GDC Number (Lead booker):

Name (2nd delegate if applicable):

GDC Number (2nd delegate if applicable):

Lab Name:

Schottlander Acc No (if known):

Daytime Telephone Number:

Email:

Lab Address

Postcode

Do you have any special dietary requirements

We will confirm your place by email and post. If you would like your confirmation details posted to another address, i.e. home, please enter your address details here:

Optional postal address if different from above

PAYMENT SECTION

Schottlander accepts all major credit and debit cards.

If you complete the payment section below we will process your payment within 48 hours (Monday to Friday) and confirm your place by email and post.

Card holders name

Card number (no spaces required)

Expiry date MM/YY

Card Security Code (CVC)

Please tick this box if you would prefer to make the payment over the telephone

We will contact you on the daytime telephone number you provided above

Thanks!

GINGIVAL COMPOSITE CHARACTERISATION COURSE BOOKING FORM

PAYMENT SECTION