Mailing List Request

Cost: $50 (+$3 for PayPal)
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/ Individual Requesting List*
Email*
Please enter an email address to receive a copy of this completed form and mailing list.
Which list(s) do you want?*
- SLP
- Audiology
- Both
Payment Options*
- PayPal (A $3 fee will be added for online payments)
- Mail Payment with printed form
Mail in payment with printed form*
I understand that if I choose to mail in payment with printed form the Board office will not receive my form submission. I understand that the most common reason for delay is error in completing the form correctly, providing the required information, and not following the instructions. Error can be avoided if you proceed through this form submission carefully, thoroughly, and accurately. If you have any questions or need assistance, call the Board of Examiners at 336-272-1828.
I understand
Check/Money Order Payments*
Checks/money orders are made payable to NCBOESLPA, and should be mailed to NCBOESLPA, PO Box 16885, Greensboro, NC 27416. The form and payment must come together. If a payment comes without a form, or vice versa, it will be returned to sender.
- I understand!
Payment Method*

American Express
Discover
MasterCard
Visa
Maestro
Supported Credit Cards: American Express, Discover, MasterCard, Visa, Maestro
Card Number Expiration Date Security Code Cardholder Name
Total
$0.00

ASLP-IC Rulemaking comment period now open

Cost: $50 (+$3 for PayPal)

What is in the mailing list?

Licensees