R4-15-205. Application for Renewal of a License

An applicant for a renewal license shall submit:

1. An application form that contains the applicants
   
   1. Name
   2. Massage therapy license number;
   3. Massage therapy license expiration date;
   4. birth date;
   5. Residence and practice addresses, and
   6. Residence and practice telephone numbers:
   7. Mailing address;
   8. E-mail address;
   9. Alien status declaration if the licensee is not a citizen or national of the United States;
   10. Declaration of whether the licensee has been charged with or convicted of a felony or an offense involving moral turpitude or prostitution, solicitation, or a related offense or entered into a plea of no contest during the two-year period immediately preceding the renewal application date and, if so the licensee shall provide the following information;
           i.    The charged felony or offense;
           ii.   The date of conviction;
           iii.  The court having jurisdiction over the felony or offense;
           iv.  The probation officer's name, address, and telephone number, if applicable;
            v.  A copy of the notice of expungement, if applicable; and
           vi.   A copy of the restoration of civil rights, if applicable;
   11. Declaration that the licensee has completed the continuing education required by A.R.S. 32-4225(E) during the two-year period immediately preceding the renewal application date or if audited, the documentation required in R4-15-303(B0; and  
   12. Signature and date of submission; and  
2. The fee required in R4-15-102 (A).