Breast Pump Giveaway Application - Breastfeeding Support Group of Pulaski, TN
Ameda donated several Purely Yours Ultra breast pumps to our group (valued at $315.99), and we hope to distribute them to mothers in our area, with preference to those who are in need and have exhausted other resources. Please fill out this form to be considered.
Whether mom is returning to work or wants a fast and easy pumping experience, the Ameda Purely Yours Ultra Double Electric Breast Pump designed for daily use, is the ideal pump. The Purely Yours Ultra comes with our lightweight and stylish Dottie Tote to discreetly carry your pump and other accessories. The Dottie Tote is made from premium easy-to-clean fabric, has an outside zipper pocket to hold a cellphone and an interior pocket to keep small pump parts handy. This comes with additional bottles and a Cool’N Carry™ tote to store and keep milk cool when away from home.
Purely Yours Ultra
Preferred contact method
Are you a member of the Breastfeeding Support Group of Pulaski Facebook Group?
What is your baby's birth date or estimated due date?
Which of the following are true?
I applied for a breast pump through my insurance and they did not cover a double electric pump
I applied for a breast pump through the Health Department/WIC
I am not eligible for WIC/Health Department assistance
I am returning to work after my baby is born
I am/am planning on exclusively pumping
I cannot afford a double electric breast pump out-of-pocket
I already have a double electric breast pump
My child has a medical condition that requires me to pump
I am hoping to pump to build my supply
I plan to pump for the times I will be away from my baby, such as errands or date night
Please write a little about why this breast pump would help you meet your breastfeeding goals.
Questions and comments
*Disclaimer - The Breastfeeding Support Group of Pulaski, TN is not responsible for any injury resulting from use of the pump or malfunction of the device.
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