Modern Endo Course Booking Form

Course places are limited so reserve your place(s) today.

Select your preferred date and location

Friday 15 March - LONDON
Friday 26 April - EDINBURGH
Friday 10 May - SOUTHAMPTON
Friday 24 May - BIRMINGHAM
Friday 7 June - LONDON
Friday 12 July - GLASGOW
Friday 13 September - EXETER
Friday 11 October - SOUTHAMPTON
Friday 1 November - SHEFFIELD

Name (Lead booker):

GDC Number (Lead booker):

Name (2nd delegate if applicable):

GDC Number (2nd delegate if applicable):

Practice Name:

Schottlander Acc No (if known):

Daytime Telephone Number:

Practice Address

We will confirm your course 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!

Modern Endodontics in a Day - Course Booking Form

PAYMENT SECTION