NCLC LASER CERTIFICATION EXAM ORDERING FORM
This form is solely for the use of authorized NCLC proctors.
Authorized Proctor Name
Exact Shipping Address
Please enter shipping address EXACTLY as the package should be labeled for mailing from the U.S.
Certified Aesthetic Laser Operator
Certified Laser Hair Removal Specialist
Certified Medical Laser Safety Officer
Certified Laser Repair Technician
Choose Type of Exam
# of Exams
If you need different types of exams,
please submit separate orders for each
Your credit card will be charged for the number of exams at the current fee for each, plus shipping when applicable. Proctor exam agreement terms are applicable.
Type Credit Card
Name on Card:
I hereby authorize charges to my credit card for the above listed examinations and shipping
Please enter the text into the box
3 Digit Security Code