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First name
Last name
Email address
Username
Password
Notes 1
Notes 2
Notes 3
Notes 4
License Number (Enter XX if you do not yet have a license number)
License Type (Electrical, HVAC, Plumbing, etc.)
State(s) licensed in
License Expiration Date
Address
City
State
Zip
Phone
Discord Handle (like: ElectricBob#9000)
Date of Birth
Drivers License (Virginia Classes Only)
Last 4 Digits of Social Security Number (Alabama Classes Only)
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