Indicate any changes below 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by indicating any changes to your personal information. Fill in your name, address, city, state (MT), zip code, and country (US) as necessary.
3. Select your license status: Active ($550.00) or Inactive ($275.00). If you have a Childbirth Specialty, remember to add the additional fee of $25.00.
4. Complete the continuing education attest statement by confirming whether you have met the required hours for renewal.
5. Answer the disciplinary question at the bottom of the form honestly and attach any necessary documentation if applicable.
6. Sign and date the renewal application to validate your submission. Ensure all fields are completed to avoid processing delays.

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