BALA Membership Application
Thank you for your interest in BALA! Once this application and your $50 dues have been received, you will receive an email from the BALA membership coordinator.
Name: *
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Credentials: *
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Company/Organization Name:
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Title/Role:
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Primary Mailing Address:
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City, State & Zip:
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Mobile Phone Number:
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Work Phone Number:
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Email Address: *
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Company Website:
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Do you rent breast pumps? *
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Professional Activities:
Professional Focus:
Would you like to be listed in our Find a Lactation Consultant public BALA directory (for IBCLCs only)? *
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