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PLS License

License Number (L-XXXX or blank)

For North Carolina Licensees only. All others continue below.

Name

First Name *

Middle Name

Last Name *

Suffix

Preferred Name (however you would like to be addressed)

Contact

Email Address *

Phone Numbers * (At least one phone number is required, but two or more are preferred.)

Business Phone

Mobile Phone

Home Phone

Business Address

Home Address

Mailing Preference
Business Name

Address 1

Address 2

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State

Zip

County (NC only)

Mailing Preference
Address

City

State

Zip

Security

Username * (3 char min, 32 char max, a-z, 0-9, _, -, 1 alpha required)

Password * (8 character minimum, uppercase, lowercase, numeric digit required)

Password Confirmation *

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North Carolina

Society of Surveyors

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