BRIAN K BLACKBURN Athletics Professional License verification

Business Entity

NOT RENEWED

License Type

Athletics Professional

Description

ATHLETICS - LICENSED FCMA SECOND

License Number

002166479-0022

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

Last Name

BLACKBURN

Business Name

BRIAN K BLACKBURN

Original Issue Date

02/08/2010

Effective Date

12/21/2011

Expiration Date

09/30/2013

City

GRAYSLAKE

State

Zip

60030

County

LAKE

Ever Disciplined

LastModifiedDate

11/21/2013