MBLEX Payment Request Form

Massage and Bodywork Licensing Examination (MBLEx) Payment Request Form

Fill out all required information. Failure to complete in full will delay processing.

Indicates required field*

First Name*

Last Name*

SSN (Last 4 digits)*

Address*

City*

State*

Zip*

Phone*

Email*

I request that payment be made to the Federation of State Massage Therapy Boards so that I can schedule my examination.

I understand that if I am a graduate that a MBLEx payment will not be issued if there are any tuition or other fees outstanding on my account.

By checking this box, I authorize this form.

Please leave this field empty.



1.800.694.5314