LAVA:

Registration

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Organizations

Organizations represent official groups that you have affiliation with as a LAVA user. Click the Add Organizations link below to see a complete list of organizations and select those you want to join.

Add Organizations Region Map

Organization(s):

Account Information

Creating an account is the first step in the Louisiana Volunteers in Action registration process. You will use your account username and password each time you log into Louisiana Volunteers in Action.

Username:

The username must be at least six (6) characters long and cannot contain spaces. Acceptable characters include alphanumeric (A-Z, 0-9) and the symbols @, ., -, and _. Usernames are not case sensitive.

Password:

Confirm Password:

Secret Question:

Secret Answer:

Terms of Service and Privacy Policy

Required field Terms of Service:

By checking this box, I indicate that I agree to the Terms of Service and have read and understand the Privacy Policy for this site. My submission of this form will constitute my consent to the collection and use of this information and the transfer of this information across the Internet to processing and storage facilities supporting this system. I also agree to receive required administrative and legal notices such as this electronically.

Required field Information Pledge:

By checking this box, I pledge to provide only correct information when completing this registration process. I also give consent to Louisiana Volunteers in Action and their designated agents to collect, use, verify, and maintain any information that is collected through the use of this site.

Required field Background Check Consent:

I hereby verify that the information submitted is accurate to the best of my knowledge. I give LDH-OPH-Volunteer Management Program permission to inquire into my educational background, references, licenses, police and criminal records, and employment and/or volunteer history. I also give permission to the holder(s) of such information to release it to LDH-OPH-Volunteer Management Program. I hold LDH-OPH-Volunteer Management Program harmless of any liability, criminal or civil, that may arise as a result of the release of this information about me. I also hold harmless any individual or organization that provides information to the LDH-OPH-Volunteer Management Program. I understand that LDH-OPH-Volunteer Management Program will use this information only as part of its verification of my volunteer registration, and that the information will be disclosed to third parties only for that purpose and only to third parties who agree to: i) re-disclose the information to additional third parties only to the extent necessary for such purposes and only to the extent that such additional third parties agree to same; and ii) receive, transmit, and maintain the information in a manner that utilizes appropriate security measures and access controls necessary to prevent unauthorized access, and re-disclose only to additional third parties who agree to same.

Name and Address

Prefix:

Example: Dr., Col., Mr., Mrs., Ms.

First Name:

Middle Name:

Last Name:

Suffix:

Example: Jr., Sr., MD., PhD, RN

Address Line 1:

Address Line 2:

City:

State:

Parish / County:

Zip Code:

Work State:

Identifying Information

Date of Birth:

Social Security Number:

SSN is an optional field that may be used to verify certain licensure information and for identification purposes.

Contact Information

Primary Email Address

Email Address:

If you have an email account, it is important for you to provide this information. Without your email address, you may miss important messages and notifications. Please note that the system will not allow two accounts with the same email address. If you do not have an email address or your email address is already registered with the system, you can learn more about obtaining a free email address by clicking here.

Confirm Email Address:

Contact Method 1

Delete

Contact Method 1:

Number to Attempt:

Pager Type:

Pager Carrier:

Pager ID/PIN:

Add Another Contact Method

Occupation Information

What is your occupation type?

Occupation:

If your occupation does not appear in the list, please select Other.

Louisiana Volunteers in Action