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Healthoregon.org/hlo Email hlo. info state. or. us Print Form ASSISTANT BEHAVIOR ANALYST LICENSE APPLICATION 1. State Lic./Cert. /Reg. Expiration Complete This Section Only If Submitting Payment By Mail Method Of Payment For Application Fee 125 License Fee 175 Please check one Cash Check Money order Purchase order Credit card see below Type of Credit Card Visa MasterCard Discover Cardholder must either be the applicant or be present at the time application is submitted Do Not Fax or Email...
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