International Academy for Rotary Endodontics



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International Academy for Rotary Endodontics
(All information must be provided to avoid rejection of your application )
NAME………………………. ……..Sex ……………….Nationality………………..
Date of Birth ……………………………. Your Degree -BDS, MDS, Endodontist
Year of BDS …………….. Year of MDS………………………
University …………………………………………………………

Employer/CLINIC Address ………………………………………………………
………………………………………………………….POSTCODE…………….
TEL: HOME………………………… …….WORK…………..……………… ………………
E-MAIL…………………………… Mob ………………………………………………………
I am doing RCTs since ………Years.. ANT/ POST
Average visits for RCTs Single/ Multiple, If multiple 2 / 3 / 4 / More
Irrigant / Irrigation techniques Used ……………………………………………………
Root Canal Instrumentation Used: Hand / Rotary,
Name of Rotary system used……………… Obturation Tech. Used………………….
Whether Using Electronic Apex Locator .. Yes / No, Brand …………………………
Rubber dam use: Yes / No
Magnification Used: Yes / No, If Yes, Loupes / Microscope
Brief details of Previous Endo courses Attended if any ………………………………………………………………………………………………

Commonly faced problems in my endo cases

……………………………………………………………………………………………………….



Email this form to icdr@hotmail.com , you can email this form as word document or image or pdf after scanning the filled form

International Academy for Rotary Endodontics, 264 Shivabasava Nagar, Belgaum, 590010, India


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