2025-2026 MALCA Form

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August 1, 2025, to July 31, 2026

Email *

You must complete this form for your MALCA membership and/or Breastfeeding Update registration to be complete.

First Name *

Last Name *

Credentials *

IBCLC

Lactation Counselor/Educator

Lactation Peer

NP/PA

PT/OT

PharmD

SLP

Student

Other:

Required

Phone Number *

Indicate E-mail where you would like to receive all your MALCA communications. *

Choose all that apply *

I give MALCA permission to share my email address with the Shelby County Breastfeeding Coalition (SCBC)

I'm interested in serving on the Board

I'm willing to serve on an "as needed" basis

I can help with the Breastfeeding Update, IBCLC Day & Health Events

I can help with accounting, administration & record keeping

I'm willing to present/speak and help with a Journal Club

I can help with website maintenance

I can help with communication/promotion & marketing

None of the above

Required

Place of Employment

Select which option you would like to participate in. *

MALCA Membership

Select the payment option that applies to you. *

MALCA Membership ONLY - $40

Group Payment (for groups greater than 10 contact malca4memphis@gmail.com for more details)

Student - $0, no continuing education hours

A copy of your responses will be emailed to the address you provided.

Submit

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