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Get Coda Renewal Form 2015-2024

Umbers of Social Security # Continuing Education Hours 12 HOURS ARE REQUIRED EACH YEAR TITLE OF COURSE DATE SPONSOR SPEAKER HOURS TOTAL HOURS FEES Postmarked by December 31: Fee $20.00 ***************** Postmarked after December 31: Include $10.00 late fee. Total fee $30.00 SIGNATURE DATE Check or Money Order Payable to: Commission Ohio Dental Assistant Certification MAIL TO: Commission Ohio Dental Assistant Certification 1501 Centerview D.

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