Membership Demographic Survey
We have been asked by United State Breastfeeding Committee (USBC) to collect demographic data on our membership. This information may be used as data to apply for grants and evaluate necessary services & continuing education opportunities. Your name will not be shared with the corresponding answers and is only being gathered to confirm your membership number. This information will NOT be sold.
What is your name?
Your answer
What is your gender?
Please select your age range.
How would you identify your race and/or ethnicity? (Select as many as apply.)
Are you interested in becoming a Board Member?
Are you interested in volunteering for any sub-committees? (Ex: Conference Committee, Legislative, etc.)
Are you an IBCLC?
Are you a CLC?
Are you a breastfeeding peer counselor? (Ex: WIC Breastfeeding Peer Counselor, La Leche League Leader, Breastfeeding USA Peer Counselor, etc.)
What is your current profession?
Your answer
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This form was created inside of Alaska Breastfeeding Coalition.