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Get California Dopl

530-6628 www.dopl.utah.gov ATHLETIC TRAINER LICENSE APPLICATION (Note: Microsoft Word users can fill in the blanks, print the form and save it for their records.) ***Please list your full legal name as it appears on your driver s license, Social Security Card, etc.*** Last Name: First Name: Social Security Number: I certify under penalty of perjury that: Middle Name: Maiden Name: I am a citizen of the United States and I have a valid US Driver License or US State ID. License/State ID N.

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