Trainee Verification Form

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Trainee Verification Form

To qualify for complimentary registration to the 32nd Annual Conference on Breastfeeding please complete this form and you will be emailed a promo code to register on Eventbrite. Please do not share that code as we will be tracking all registrations.

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* Indicates required question

Email *

Your email

Name *

Your answer

Address *

Your answer

Phone number *

Your answer

Degree *

MD

BS/BA

MS/MPH

Other:

Required

Institution/Training Program/Leaarc Accredited (Pathway II) IBCLC Programs (only) *

Your answer

City/State *

Your answer

Program Director

Your answer

Level of Training *

Medical Student

Resident

Fellow

Nursing Student

Nurse Practitioner Student

Lactation Student

Required

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