Relinquish License Request

Submit this form if you no longer want to keep your license active and are exempt from licensure.

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Thank you for notifying the Board. You will receive email confirmation when you click SUBMIT.




P.O. Box 97833, Raleigh, NC 27624-7833  -  PH: 919.834.3661  -  FAX: 919.834.3665  - Email: