Validation Task Force for Electrical Work Statewide

Louisiana State Licensing Board for Contractors

This form must be submitted by the person authorized to attend the three sessions. (* indicate that a field is mandatory)

Full Name*
Enter your first and last name
Company*
Enter the name of your company
Position Title*
Enter your position and title
License*
Enter your LSLBC license #
Work Address*
Enter your work address

Street Address Address Line 2 City State ZIP Code
Email*
Phone Number with area code*
Years of Contracting Experience*
Please enter a number from 0 to 100.
Describe prior experience.*
Please describe prior experience as it relates to Electrical Work. Type "NA" if this does not apply to you.
Task Force Interest*
Why are you interested in being a part of this Task Force?
Previous Experience*
Were you previously involved in the development or evaluation of the Electrical Work examination?
- Yes
- No
Availability*
Are you able to participate in all scheduled workshops?
- Yes
- No
Schedule Conflicts
List any dates you will be unable to attend due to scheduling conflicts.
Coworker's Name
If you have co-workers and/or employees who may be interested in participating in the workshop, please enter their name and email address where we may send additional information.
First Last
Coworker's Email
By checking the "I agree" box below, I acknowledge that I would like to be considered for the Validation Task Force and agree to participate in one or more of the workshops associated with these redevelopment activities.
Acknowledgement*
- I agree

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By checking the "I agree" box below, I acknowledge that I would like to be considered for the Validation Task Force and agree to participate in one or more of the workshops associated with these redevelopment activities.