STATE OF KANSAS
BOARD OF OSTEOPATHIC

EXAMINATION AND REGISTRATION

 

ORIGINAL

CERTIFICATE No. Oa 3 J

 

EXAMINATION FEE

 

RECIPROCITY FEE

RECEIVED eel ee AhlhenS ALD
i SOA Vem sO DOLLARS

 

5 YRS. PRACTICE FEE

 

DUPLICATE
CERTIFICATE FEE

 

RECIPROCITY
ENDORSEMENT FEE

 

CERTIFIED COPY
OF GRADES FEE

 

ANNUAL i
REGISTRATION FEE a

 

 

 

 

 

 

owe anes 5% o> we. 1a

  
 
 
 

Liat

BOARD OF OSTEOPATHIC EXAMINATION AND REGISTRATION

 

} SECRETARY

 

 

 

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