Become a LACN Member:

Please Fill the following form out to become a member of LACN:

Mission Statement: The mission of the Lousiana Association of Crisis Negotiators is to establish and maintain close working professional relationship between crisis negotiators and provide training opportunities to improve the quality of service to the communities we serve.

All Fields marked with an (*) are Required.

PERSONAL CONTACT INFORMATION:

Title:*

First Name:*

Last Name:*

Department/Agency Name:*

Your Title/Rank within Department/Agency:

Email Address:*: IMPORTANT NOTE: The email address provided will become your "Username" to access the "Member's Area."

Confirm Email Address:*

Password:*

Confirm Password:*

Primary Phone #*

Fax#:

DEPARTMENT/AGENCY INFORMATION:

Department/Agency Address:*

Department/Agency City:*

Department/Agency State:*

Department/Agency Zip Code:*

Biographical Information:

Date of Birth(mm/dd/yyyy):

Age:

Please Check all that Apply:: Hostage/Crisis Negotiator Team Member
Hostage/Crisis Negotiator Team Leader
Tactical Team Member
Tactical Team Leader
CNT/Tactical Liaison
Technical Advisor
Administrator
Other

Membership Information:

Approximately How Long Have You Been a Member of the LACN? (select one):

Are You a Mental Health Professional?(select one):

Are You a Clergy Member?(select one):

Approximately How Many Call-Outs Does Your Team Respond to Annually?:

Approximately How Many Officers/Individuals Does Your Department/Organization Employ?:

Is Your Department Equipped with a Crisis Response Throw Phone System? (select one):: No
Not Sure/Don't Know
Yes

Crisis Response Throw Phone System Type(select ALL that apply):: Direct-Link Crisis Response System
836 Technologies
ENT Callbox
Rescue Phone
Don't Know/Not Sure
My Department is NOT Equipped with a Crisis Response Throw Phone System

Applicant Digital Signature:*

I Have Read and Agree to LACN's Website Terms, Conditions, & Privacy Policy*

SUBMIT

Designed, Developed, and Hosted by:
Enforcement Technology Group Inc.
(ETGI)