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Get MI MMP 3502 2013-2024

CHANGE FORM** $10.00 fee Required • Please call our office if you have any questions PROOF OF MICHIGAN RESIDENCY IS REQUIRED • Submit an Application Form (instead of the Change Form) if you are applying or renewing your registration or if your current card is expired • Submit ALL documents in ONE envelope • We recommend the applicant/patient submit the change form packet • Type or print legibly • Incomplete Change Forms will not be processed and a notice will be sent to the pati.

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