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Get Illinois Industrial Hygienist License Form

Street or P.O. Box#) City: (Apt./Suite) State: Day Phone Number: ( Zip Code: ) Fax: Internet E-mail Address: Application For: Each Initial Licensure $200 Renewal of current license* $50 Late renewal of current license** $100 Rene wal of inactive license $50 Renewal of expired license*** $200 Duplicate or replacement license $15 Wall certificate $15 Current/suspended/revoked roster $15 Expired/inactive roster $15 Total enclosed: $ * ** *** **** Total $0 Must be postma.

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