DC Breastfeeding Coalition Membership Application (Bronze Level)
Name:
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Credentials/Experience:
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Address:
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Phone Number (daytime):
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Phone Number (evening):
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Website (if applicable):
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Email Address:
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Workplace:
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Age range
Gender
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How do you describe your race/ethnicity?
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How would you describe yourself? (hardworking, goal-oriented, breastfeeding mom, etc.)
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Are there any special areas of interest/projects that you are working on?
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Other organization affiliations:
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How did you hear about DCBFC?
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What are your career goals?
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Tell us about your educational background, including certifications.
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What is your learning style?
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How do you prefer to communicate (phone, email or in person) with your mentor?
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What days and times are you available to communicate with your mentor?
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As a mentee, what is your expectation of your relationship with your mentor?
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What specific skills or talents do you need assistance in developing?
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As a member, what will you bring to the organization?
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Which committees are you interested in serving on?
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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