Normalize Breastfeeding Tour #NBFtour

Thank you for your interest in registering for the official Normalize Breastfeeding Tour. This opportunity to participate is by invitation only. If you have been invited to register by your local hospital or health organization, please submit your information below and we will contact you by text message and email to confirm your session date and time. Anyone feeding their baby with breast milk is allowed to participate: breastfeeding, pumping, and supplemental nursing is all allowed as it is YOUR story.

........
Check out what we have done so far!
PRESS: press.normalizebfing.com

Copyright © 2017 - Normalize Breastfeeding - NormalizeBreastfeeding.org

Email *

Confirm Email address *

Your email will be used to send you an online gallery.

Name *

Mobile Phone *

Standard text message rates apply.

Address *

Where should we ship your prints?

Select an #NBFtour Date/Location. This trip was Sponsored by: *

Oct 22 2016 Charlotte, NC - Novant Health Hospital - 0 SEATS OPEN (Reg. CLOSED 10/15)

Aug 4-5 2017 Philadelphia, PA - Philadelphia Department of Health - 20 SEATS OPEN (Reg. CLOSES 8/2)

How old is your nursling? If you are tandem nursing, you can check more than one box. *

Did you know the World Health Organization recommends breastfeeding for at least 2 years?

0-3 months

4-7 months

8-12 months

13-18 months

18 months - 23 months

2 years

3 years

4 years

5+ years

I am not currently nursing, but would like to show my support for this cause.

Required

Select an #NBFtour V-neck Tshirt Size *

Select a tshirt to best suit you. Our Ladies Slim-Fit Tees run small so please order 1 size bigger. Our unisex tees run to fit for your comfort. Both are v-neck.

Share Your Breastfeeding Story *

Write only 7-10 sentences. This story will be Featured on Blog With Your Photo. *If you are military begin with your CAC ID info (CAC ID EXP - 2015 JUL 19.) **Email a photo of your CAC ID to normalizebreastfeeding@gmail.com for verification.

Model Release *

I am a willing participant in the Breastfeeding Awareness Photography Project for NormalizeBreastfeeding.org. I give Vanessa A. Simmons permission for my breastfeeding story, photographs, and video taken of the people listed below to be printed and published on the web for promotional and marketing purposes for Normalize Breastfeeding. I understand that the images may be sold in digital form and/or print on the website to further promote breastfeeding worldwide. I understand that these photos or video may be viewed by anyone in the world, but no identifying information will be displayed. I, (YOUR NAME), am the parent or legal guardian of the following, child(ren) under 18 years of age, (LIST NAMES OF MINORS) and I give permission for their images to be printed and published. - (ELECTRONIC SIGNATURE - YOUR NAME HERE)

I am 18 years or older and signing for myself.

I am 18 years or older and signing for myself and a minor/s.

Required

First and Last Name of Your Nursing Child/Children

separate with commas

Terms of Agreement

I understand each of the following terms of agreement with my initials below:

I am willing participant of the public Normalize Breastfeeding photography project by Vanessa A. Simmons. *

your initials

I am available to participate on one/all of the tour dates listed above for the location which I have selected. *

your intials

If my baby weans before my reserved session, for any reason, I may exchange my breastfeeding session for a portrait session to take place on the same date at the same time. *

your initials

My images may be used online by a third party, with the permission of the photographer. (ie. Huffington Post, BabyCenter UpWorthy) *

your initials (if you do not want your images to be considered for the press, please type "decline".)

I will receive an email to view a shared gallery of images with which I am required to select my final images within 7 days of the reserved session. *

your initials

I will receive printed images by mail 2-3 weeks after my selections have been submitted. *

your initials

A 4-6 week delay may occur to receive campaign items that may be out of stock during the time of my session. *

your initials

It is my responsibility to communicate with the photographer, Vanessa A. Simmons, about any unforeseen circumstances that may prevent me from participating, viewing the online gallery, or downloading the files for non-commercial use, by emailing her directly at normalizebreastfeeding@gmail.com or texting her at 760-544-3686. *

your initials

Electronic Signature *

USE ALL CAPS - (ex: YOUR NAME)

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms