Enter your name as you want it to appear on your LLIR badge.

First:   Last:

Contact Information

Delete information to change and replace it with updated details.

Number, Street, and Unit:

City:      Postal code: no spaces

Phone number: 10 digits

Error messages that may result from submitting the form become visible only after the form is submitted with errors.


The lines below replace or follow the Submit and Cancel buttons when processing is successful.

Your name and contact info is updated.

You can continue by selecting from the menu or logout.

This form should initially show the user’s data currently stored in the database. The mockup cannot access the database so the form opens with sample data.