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Get Application For Athletic Trainers License - In

064 E-mail: pla5 pla.IN.gov State Form 46715 (R9 / 4-11) Approved by State Board of Accounts, 2011 * Your Social Security number is being requested by this state agency in accordance with IC 25-1-5-11. Disclosure is mandatory and this record cannot be processed without it. APPLICATION FEE APPLICANT Attach one (1) passport type quality photograph of yourself taken within the last eight weeks. DATE FEE PAID (month, day, year) RECEIPT NUMBER LICENSE NUMBER LICENSE ISSUANCE DATE (month, day, yea.

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