IBC Organizational Membership Intake Form
Organizational memberships should be completed by dedicated individuals who will help their organization align with the IBC and who can fully represent their organization and make decisions on its behalf. Organizational membership requires identifying a primary and secondary representative who will be expected to share IBC communications, events, and information with staff and partners. Organizational members are also responsible for communicating back to IBC leadership about strategic priorities through the utilization of surveys and success stories. Becoming a member of the Indiana Breastfeeding Coalition (IBC) is currently free for all organizations and individuals.
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Email *
Organization Name: *
Organization Address: *
Organizations' Mission:
Primary Contact Name: *
Title of Primary Contact: *
Email address of Primary Contact: *
Secondary Contact Name: *
Title of Secondary Contact: *
Email address of Secondary Contact: *
May we list this organization as a member on our website? *
May we list this organization as a member on our promotional materials? *
Todays Date:
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