Appeal Assistance Registration Form

Appeal Assistance

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Location: LSUA ERC Lab 105 (Get Directions)
Contact: (318)473-6417 or 888-473-6417

Registration Form

Contact Information

First Name:*
Last Name:*
Phone Number: (ex. 3181234567)
Email Address:(ex. you@email.com)
What time would you like your Appointment:

Once you submit this form you will receive a confirmation e-mail, if you provided an email, detailing your registration information. We look forward to seeing you soon.

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