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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).
  • Please enter an email address to receive a copy of this completed form.
  • $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.