The B.L.A.C.K. Course Registration Inquiry Form
We are collecting information from interested parties who would like to take the course or host the course.

The B.L.A.C.K. Course is a full scope lactation and breastfeeding education course made by and for Black People and folks supporting Black breastfeeding. This course is designed to be a prep course for Aspiring IBCLC’s and Breastfeeding counselors.

Sign in to Google to save your progress. Learn more
Email *
Are you interested in hosting or taking the course? *
First Name *
Last Name *
Address *
Phone number
Current Lactation Certifications
Clear selection
Attendees: do you need this course for IBCLE requirements?
Clear selection
Attendees: when do you plan to take the IBCLC exam?
Attendees: would you qualify for scholarship opportunities based on income?
Clear selection
Name of the organization or agency interested in hosting
Will the hosting organization/agency be collaborating with other entities? If so, please list the names below.
How many attendees do you plan to host?
Do you have a venue to host The B.L.A.C.K. Course?
Clear selection
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy