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DC Breastfeeding Coalition Membership Application (Gold Level)
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Name:
Your answer
Credentials/Experience:
Your answer
Address:
Your answer
Phone Number (daytime):
Your answer
Phone Number (evening):
Your answer
Website (if applicable):
Your answer
Email Address:
Your answer
Workplace:
Your answer
Age range
Under 18
18-24
25-34
35-44
45-54
55-64
65 and older
Clear selection
Gender
Your answer
How do you describe your race/ethnicity?
Your answer
How would you describe yourself? (ex: hardworking, goal-oriented, breastfeeding mom, etc.)
Your answer
Are there any special areas of interest/projects that you are working on?
Your answer
Other organization affiliations:
Your answer
How did you hear about DCBFC?
Your answer
Which committees are you interested in serving on?
Program Development
Website/Social Media
Membership/Public Relations
Finance/Fundraising
Thank you!
Thank you for taking the time to submit this interest form! We look forward to serving the community with you.
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