Virginia Law Enforcement and National Security Network (VLNSN)
Registration Form
Notification e-mail address must be agency affiliated. Please, no personal e-mail addresses.
Please complete the form below, no partial applications accepted.

CONTACT INFORMATION
(Type your name as it should appear on
certificates of completion)
First Name  *

Last Name *

Position/Title/Rank:  *

Are you sworn law enforcement? *
Yes   No 

Phone Work: (###-###-#### - ext) *

Mobile Phone: (###-###-####)

E-mail:  * Use your agency address

WEBSITE ACCESS
Password: *
Create a password for site access and to
modify your contact information

GROUP ACCESS
List any VLNSN Groups you want access to.

AGENCY / ORGANIZATION
Agency/Organization Name:  *

Federal State Local  MiltaryOther
Address: *

Address 2:

City: *

State:*

Zip code:*

SUPERVISOR / EMPLOYMENT VERIFICATION CONTACT
Full Name*

Supervisor's Title*

Phone Work:* (###-###-####)

Supervisor's Email Address:*
(Organization email addresses only)

Confirm Your Supervisor's Email Address:*