HTML Preview Office Of Occupations And Professions - Form Template For Applications page number 1.


PUBLIC PROTECTION CABINET
OFFICE OF OCCUPATIONS AND PROFESSIONS
P.O. Box 1360, Frankfort, Kentucky 40602 ~ 911 Leawood Drive, Frankfort, Kentucky 40601
Phone: (502) 564-3296 Fax: (502) 564-4818 ~ http://dop.ky.gov
MAILING LIST REQUEST
12/2012 Page 1 of 1
Please complete the following information to request a licensee mailing list. All lists are created in
Microsoft Excel. A header row will be provided in the data. Please choose a format in Step Three
below. All lists are provided electronically via email.
Step One: Provide Your Contact Information
____________________________________________________________________________________
Contact Name Date of Request
____________________________________________________________________________________
Email Address (List will be sent to this address) Primary Phone Number Secondary Phone Number
____________________________________________________________________________________
Company Name
____________________________________________________________________________________
Street Address City State Zip Code
Step Two: Indicate Board You Are Requesting Data From
(Visit http://dop.ky.gov for a list of boards serviced by the Office of Occupations and Professions)
____________________________________________________________________________________
Board Name*
*Costs for mailing lists are $15 per board (A separate check or money order must be sent for each
board requested)
Step Three: Choose a Format
Microsoft Excel (2010) Standard
Microsoft Excel (1997-2003) Standard
Text (Tab Delimited)
CSV (Comma-Delimited)
Step Four: Return Your Form
Please mail your completed form, along with a Fifteen Dollar ($15.00) check or money order (if
requesting more than one board, please send separate checks or money orders) made payable to the
Kentucky State Treasure to:
Office of Occupations and Professions
P.O. Box 1360
Frankfort, KY 40602
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