The License Commission of The Americas
8417 Oswego Road #131
Baldwinsville, NY 13027
800-783-9980 TLCTA @ bluejay.net
RENEWAL LICENSE APPLICATION FOR:
___ Biofeedback Therapist
___ Traditional Homeopath
___ Traditional Naturopath
Applicants must include a copy of
their current:
Highest degree
attained, list of licenses held and a list of healthcare certifications: Contact
information by telephone, cell phone, fax and email: _______________________________________________________
Name, Address, City, State or Province, Zip Code and Country:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Website:
______________________________________________________________________
Signature