Membership Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberEmail* Membership InformationMembership Type*IndividualStudent or WIC Peer CounselorStay-at-home parent or WIC recipientNon-Profit OrganizationFor-Profit OrganizationSilver Level Corporate MembershipGold Level Corporate MembershipPlatinum Level Corporate MembershipMembership period: September 1 - August 30New or renewal?*NewRenewalIf applicable: As a MBC MEMBER ORGANIZATION (for profit or non-profit), would you like your organization to be listed on the MBC website member organization page? Yes No This page can be seen at https://massbreastfeeding.org/about/member-organizations/If applicable: As a MBC CORPORATE MEMBER (silver, gold, or bronze), would you like your organization to be listed on the MBC donate page? Yes No This page can be seen at https://massbreastfeeding.org/donate/Please enter a contact emailWe would like to contact you to gather more information about your organization (i.e. logo and description) . Please list a contact email. GenderFemaleMaleOtherAge18-2425-3637-4445-5960+OccupationHealth care professionalSome other professionStay-at-home parentStudentWIC peer counselorHeritage* Caucasian African-American/African descent Asian Latino/Latina Native American Other How did you heart about us?From a friend/family/co-workerFrom seeing our name on materialsFrom a support groupAt a meeting or conferenceI'd like to learn more about becoming a valued committee member of: Select All D.R.I.V.E. - transforming the lactation field while focusing on diversity, equity & inclusion NIPP - help plan fun mini session topics for CEU credits where we can gather, learn, & chat ZipMilk - be apart of breastfeeding support breakthroughs as we work to improve and revamp ZipMilk across the country Annual Breastfeeding in the Bay State conference committee Ban the Bags - combat the infant formulas that are still prevalently marketing harmful information to moms We have many exciting things coming up in 2022. Click on committee you would like to learn more about and we will reach out with more information! Become an active committee member (1-2 hours per month) and earn discounted admission to our annual conference.Membership fees due today: $0.00 If you are paying dues to join, you will be redirected to PayPal to complete your membership registration. Thank you!
