Update Your Information

STOP: If you wish to notify BSRB of your name change go to http://ksbsrb.ks.gov/docs/default-source/policies/info-on-name-changes.pdf?sfvrsn=2 for more information.

Name:

Please enter your name (first and last)

Old Address:

Please enter your old address.

Old City:

Please enter your old city.

Old State:

Please enter your old state.

Old Zip Code:

Please enter your old zip code.

Old Email Address:

Please enter your old email address.

Old Phone Number:

Please enter your old phone number.

License Number

New Address:

Please enter your new address.

New City:

Please enter your new city.

New State:

Please enter your new state.

New Zip Code:

Please enter your new zip code.

New Email Address:

Please enter your new (current) email address.

New Phone Number:

Please enter your new phone number.

Home or Business Address

Home
Business

Additional Changes to Request:

Please enter any additional information you need changed.

Type the code from the image