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North Carolina Board for Licensing of Geologists P.O. Box 41225 Raleigh, NC 276291225 Phone: (919) 8509669 Fax: (919) 8721598 Email: barbara.geiger@ncblg.org www.ncblg.orgApplication for Reinstatement

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Obtain the form from the North Carolina Board website or office.

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Read the instructions carefully before filling out the form.

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Individuals or entities seeking to apply for a license or certification from the North Carolina Board.

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Form North Carolina Board is a document required by the state of North Carolina for certain entities to report financial information.

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