FORM 1: LAC PROFILE

This form should be accomplished by the LAC Facilitator and its members at the first LAC
session.

REGION:

LAC ID (name or number): Number of LAC members:

Name of LAC Facilitator: Designation/Position:

LAC Members
NAME Male/ Female DESIGNATION/ DIVISION/S Contact details Preferred contact
POSITION (email, mobile mode (email,
number) phone, Skype,
Zoom, Google
Meet, Viber, FB)