Beginning on January 1, 2012, an applicant for a license or renewal of a license under this chapter shall provide the board with:
1. Public record address. A contact address, telephone number and e-mail address that the applicant is willing to have treated as a public record, such as a business address, business telephone number and business e-mail address; and
2. Personal address. The applicant's personal residence address, personal telephone number and personal e-mail address.
If the applicant is willing to have the applicant's personal residence address and telephone number and personal e-mail address treated as public records, the applicant shall indicate that in the application and is not required to submit a different address under subsection 1.