| Application fee (non-refundable): | $350 |
| Initial licensing fee: | $350 |
| Unlicensed activity fee: | $5 |
| NICA fee (choose one NICA designation): | |
| NICA Exempt | $0 |
| NICA Non-Participating | $250 |
| NICA Participating | $5,000 |
| Total | $705 plus appropriate NICA fee |
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