44:58:03:02Application forms -- Contents.

An application shall contain the person's name; signature; full address; professional license number; type of professional practice; a statement related to conviction of a felony under state or federal law; and a statement related to the denial, revocation, or surrender of a professional license or registration to handle controlled substances. Applications to conduct research and instructional activities with controlled substances as covered by subdivisions 44:58:02:20(3) and (4) shall include evidence of a valid DEA registration to conduct such research and a copy of the research protocol or a statement describing the instructional activities. Applications to manufacture controlled substances listed in Schedule II shall include evidence of a valid DEA registration to manufacture the substances.

Source: 1 SDR 30, effective October 7, 1974; 6 SDR 93, effective July 1, 1980; 11 SDR 36, effective September 11, 1984; 25 SDR 48, effective October 1, 1998.