LACN Membership Application

APPLICATION PROCEDURE:

1. Fill out all information in the fields below.
2. Click Submit.
3. The Next Page will display a printable version of your application for you to print.
4. Please print the formatted application and mail it to us along with a check for $25.00
(made payable to LACN)

Louisiana Association of Crisis Negotiators
C/O Sgt. Robert Guilbeaux- LSP
2020 West Pinhook Rd., Suite 401
Lafayette, LA 70508

5. You will be notified upon approval of your membership. During the waiting period you can check the status of your application at any time by clicking the Check Membership Status button on the Join Us page.

Applicant Information:
First Name:
Last Name:
Department / Agency:
Rank / Title:
***Email:	***Will Also be used as your login username upon membership approval
Phone:
Fax:
Agency Information:
Address:
City / State / Zip:
Biographical Information:
Date of Birth:	/ / i.e.. 07/07/2007
Age:
Please Check all that Apply:	Crisis Negotiator Correctional Officer Mental Health Professional Other
Membership Information:
Applicant Digital Signature:	Please type your full name to serve as your signature I Accept By clicking "I Accept" you acknowledge that the above name is to be linked to your application and shall hold the same value as your legal signature. Also by checking this box you attest to the above information as true and current to the best of your knowledge on the date and time of this application.
	After completion: After completion of this form the next page will generate a printable version of your application to be printed and mailed with your membership dues to: Louisiana Association of Crisis Negotiators C/O Sgt. Robert Guilbeaux- LSP 2020 West Pinhook Rd., Suite 401 Lafayette, LA 70508