Registration Request · NAAVI Portal

Advocate Organization

Advocate First Name

Advocate Last Name

Advocate Agency Email

Organization Type

First Name

Address Line 1

Middle Name

Phone 1

Address Line 2

Last Name

Phone 1 Type

City

Suffix (jr., III, etc.)

Phone 2

State

Sex

Phone 2 Type

Zip

Date of Birth

Zip Code

Preferred Language

Federal Case

NoYes

What is your relationship to the victim?

Where did the offense occur?

What are the Circuit Court Case Numbers? (if known)

Date of Sentence

Length of Sentence

Inmate

Comments

Agree to Terms and Conditions

NoYes