Nitrous Oxide Course Application Please enable JavaScript in your browser to complete this form.Name *Birth DateAddressAddress Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Applicant's CellEmployerEmployer AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBusiness PhoneBusiness FaxDate you plan to attend course:Course Includes:• This course is designed to provide Dental Auxiliary (DAI, DAII or RDH) with the background knowledge necessary for monitoring nitrous oxide-oxygen analgesia • Students who complete all 7 hours of instruction will be awarded a certificate of achievement. This certificate allows for the monitoring of patients using nitrous oxide under the direct supervision of a licensed dentist in North Carolina • Clinical aspect is covered in course with short exam Approved by the Dental Assisting National Board (DANB) and the NC State Board of Dental Examiners. CE credits: 7.0 hours. Approvals are not endorsements by Governing agencies. _________________________________________________________________________________________________________ **The cost of the course is $300.00 with lunch provided. You will need to pay a deposit of $150.00 to hold your place in the course. Cancellation, refund, and requirements policy:** A full refund of all monies will be made to any applicant who cancels the enrollment agreement within THREE business days of the first class. All applicants must have at least one year of experience in clinical applications (DA1) all DA2 and CDA welcome. Submit