Mailing List Request

Cost: $50 each
Please note that lists will be sent in Microsoft Excel format.
What is in the mailing list?
Names, mailing addresses, field of practice, license number, issue date, expiration date, and status (Temporary or Permanent).
Name of Company Requesting List*
Email*
Please enter an email address to receive a copy of this completed form.
Which list(s) do you want?*
- SLP
- Audiology
- Both
Total
$0.00
Upon submission of this form, an email will be sent to the address provided above. The email will contain an attached PDF and a link to a PDF of the form you completed. Please print your form and return with payment.

Checks/money orders are made payable to NCBOESLPA, and should be mailed to:
NCBOESLPA
PO Box 16885
Greensboro, NC 27416

The form and check/money order MUST come together. If a check/money order comes in without a form, or vice versa, it will be returned to the sender.