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Get AZ ARRA-4X 2014

HMENT TO ARRA-4 FOR THE REGISTRATION OF A DENTAL, MEDICAL, PODIATRIC, OR VETERINARIAN . DIAGNOSTIC X-RAY SOURCE OF RADIATION (Complete 1 ARRA-4X form for EACH unit you are applying for registration) 1. Facility Name: Street Address: City and Zip: 2. Registration Number for current registrants: 3. Date: 4. Your Name and Title: 5. Machine Type (check applicable type of diagnostic x-ray): 6. - or NEW Applicant Radiographic Bone Density Intra-Oral Radiographic/Fluoroscopic Mammogr.

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