North Carolina Board of Massage & Bodywork Therapy

APPLICATION REQUEST FORM

For Licensure as a Massage and Bodywork Therapist
in the State of North Carolina
 

 

__________________________________________________________________________________________
NAME
 

__________________________________________________________________________________________
MAILING ADDRESS
 

__________________________________________________________________________________________
CITY                                                              STATE                       ZIP CODE
 

__________________________________________________________________________________________
WORK PHONE                                                        HOME PHONE
 

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E-MAIL ADDRESS (optional)
 
 

INSTRUCTIONS:

Print out this form, and send to the Board with a $20.00 Application Fee.
This fee shall be in the form of a money order or certified (bank) check.
No personal checks, cash or credit cards will be accepted. Mail to:

North Carolina Board of Massage & Bodywork Therapy
Post Office Box 2539  •  Raleigh, NC 27602