(a) Nombre, edad y dirección residencial y postal del profesional inscrito en el mismo;
(b) fecha de la solicitud de registro;
(c) número de registro de la solicitud y, posteriormente, el de la licencia;
(d) descripción de la preparación académica y la experiencia profesional del solicitante;
(e) fecha en que la Junta tomó la acción correspondiente a la solicitud;
(f) firma de la persona admitida a ejercer la profesión, quien deberá consignar la misma cuando se le entregue la licencia, y
(g) cualquier otra información que por reglamentos determine la Junta.
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