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. Dues can be sent via PayPal at bayarealactationassociates@gmail.com or email for treasurer's address if you want to pay by check.
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Email *
Name: Last, First please *
Credentials: *
Company/Organization Name:
Title/Role:
Primary Mailing Address:
City, State & Zip:
Mobile Phone Number:
Work Phone Number:
Email Address: *
Company Website:
Do you rent breast pumps? *
Required
Professional Activities:
Professional Focus:
Would you like to be listed in our Find a Lactation Consultant public BALA directory (for IBCLCs only)? *
Required
BALA is interested in increasing its outreach to underrepresented and underserved communities. If you need help or want to help - here is one option. Please include on PayPal. I will donate to the BALA Scholarship for  Diversity Support and Outreach, and Dues Assistance the following amount:
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I am a member of an underrepresented / underserved community. I request assistance paying this year's dues of $50. I am able to pay this much:
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