Request an Account

Please fill in the information below and click submit to request a new Virtual Louisiana user account. Required fields are marked with a red asterisk (*). Please do not submit more than one request. If you have not received a response after a week, you may send an inquiry to

Warning: date(): It is not safe to rely on the system's timezone settings. You are *required* to use the date.timezone setting or the date_default_timezone_set() function. In case you used any of those methods and you are still getting this warning, you most likely misspelled the timezone identifier. We selected the timezone 'UTC' for now, but please set date.timezone to select your timezone. in /www/virtualla/site/views/home/request_user.php on line 10


First Name *
Middle Initial
Last Name *
Job Title *
Organization *
Discipline *
Mailing Address *
(PO boxes will not be accepted)
Address (cont.)
City *
State/Province *
Zip/Postal Code *
Parish/County *
Phone ( ) - *     Ext.
E-mail *
(Only government or military addresses will be accepted)