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Change of Address Request

 

Fill out the following form to submit your address change to The National Board of Surgical Technology and Surgical Assisting (NBSTSA), formerly the LCC-ST so we may update our records accordingly.

 

First Name:
Last Name:
Daytime Phone:
Email Address:
Certification Number:
 
New Address
  
Address:
Address Continued:
City
State
Zip Code
 
Old Address
  
Address
Address Continued
City
State
Zip Code
   
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