HTML Preview Mailing List Request page number 1.
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NORTH CAROLINA BOARD of MASSAGE
AND BODYWORK THERAPY
www.bmbt.org
Mailing Address: PO Box 2539, Raleigh, NC 27602 Phone: 919.546.0050
Location Address: 150 Fayetteville Street, Suite 1900, Raleigh, NC 27601
Mailing List Request Form
INSTRUCTIONS:
Print out this form and mail with the $75.00 fee for a current mailing list (this list does not
include email addresses). The fee shall be in the form of a money order, cashiers check or
certified (bank) check only. No personal checks, cash, credit cards or company checks will be
accepted. Do not forget to sign the second page. Mailing lists will be emailed within ten (10)
business days of receipt of your request form.
Mail completed form with $75 fee to:
NC Board of Massage and Bodywork Therapy
PO Box 2539
Raleigh, NC 27602
Name of Company: _____________________________________________________________
Person Completing Form: ________________________________________________________
Signature: ____________________________________________ Date: ___________________
Mailing Address: ______________________City:____________State:________Zip:__________
Business Phone: ______________________ Home Phone: ______________________________
Email Address: _________________________________________________________________
(Please PRINT; all mailing lists are delivered by email)
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Revised 02.2012