New Jersey Breastfeeding Coalition Membership Form
Payments made Oct 1, 2018 -Sept. 30, 2019 are for 2019 membership
* Required
Email address
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Your email
Name
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Your answer
Email (required for Google Group distribution list; how we notify members about upcoming meetings and other announcements)
*
Your answer
Home Street Address
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Your answer
City
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Your answer
State
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Your answer
Zipcode
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Your answer
Personal Phone Number
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Your answer
Credentials
Your answer
Affiliation
Workplace/Organization you represent
Your answer
Are you interested in serving on a committee?
Communication/ NJBC Promotion (Including social media, FB, Twitter, Instagram, and Website)
Access to BF Support Services ( Including Worksite recognition, Insurance Reimbursement, ZipMilk, Disparities, and IBCLC licensure)
Legal Affairs Including legislative updates andBF Rights)
Annual Membership $30
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MAIL IN: Please make checks payable to and send to: New Jersey Breastfeeding Coalition c/o Marilyn Hines, 132 Spring Street, Millburn, NJ 07041
PAYPAL: use link on website to send payment of $30 to online@breastfeedingNJ.com
A copy of your responses will be emailed to the address you provided.
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