I, ..........................., (name of applicant) am an applicant for a license to practice chiropractic who is waiting to take the Board's examination. I have been informed by my supervising chiropractor .......................... (name of supervising chiropractor) of the content of the provisions of NAC 634.368. I understand those provisions, and I agree that I will not perform a chiropractic adjustment or manipulation except under the direct supervision of my supervising chiropractor or any act prohibited by subsection 5 of NAC 634.368 during this supervisory period.
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(date) (signature of applicant)
Nev. Admin. Code § 634.368
NRS 634.030, 634.105