REGISTRATION FORM
Developing Dental Educators Course
8 June, 9 June, 2 July & 8 July 2015 - Unipart Conference Centre, Oxford
This course is essential for DF1 and Therapist Foundation Training Programme Trainers for 2013 – 2014 schemes.
Please note you must attend all four days.
This course is open only to dentists and therapists. If you are neither, please contact Liz Imlah (01865 785513 or
email: liz.imlah@thamesvalley.hee.nhs.uk) for details of the next Practice Staff Development Programme.
Please fill in your details below
Name:
Dentist
Dental Therapist
(Please state which)
GDC Number:
NHS Performer List Number (dentists only)
Practice/Hospital Name:
Practice/Hospital Address:
Telephone Number:
Email:
Please tick all that apply
I have applied to be a DF1 Trainer 2015-2016
I have applied to be a Therapist Foundation Trainer 2015-2016
I am a trainer/Superviser for DF2/Speciality dental trainees (Please give details)
I am a Training Programme Director
I will attend ALL four days
Please return this form to Liz Imlah by email or post to: The Dental School, Thames Valley House, 4630 Kingsgate,
Oxford Business Park South, Oxford, OX4 2SU.
IMPORTANT
If you have not already done so, please register on the Oxford and Wessex Dental School Course booking website
(www.oxforddeanery.nhs.uk; follow the links to the ‘Dental school’ and ‘Dental Courses’) so that we can enrol you
on the course and send further information.