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Registry Application Form

The following form must be downloaded, printed, signed and returned to the PMHA office.  Fees may be
paid online from the link provided on our Fee Schedule.

PDF files included on this page require Adobe Reader available for free here.

 
 
Address: P.O. Box 802, Georgetown, KY 40324
Phone: (502) 535-4803 • Cell: (270) 735-5331 ·
E-mail: