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.
* Required
Name:
*
Your answer
Credentials:
*
Your answer
Company/Organization Name:
Your answer
Title/Role:
Your answer
Primary Mailing Address:
Your answer
City, State & Zip:
Your answer
Mobile Phone Number:
Your answer
Work Phone Number:
Your answer
Email Address:
*
Your answer
Company Website:
Your answer
Do you rent breast pumps?
*
Yes
No
Required
Professional Activities:
Private practice
Staff IBCLC in hospital or other setting
Other:
Professional Focus:
Breastfeeding
Birth assistance (doula/midwife/nurse)
Childbirth education
OT/PT/SLP
Cranial Sacral Therapist
Other:
Would you like to be listed in our Find a Lactation Consultant public BALA directory (for IBCLCs only)?
*
Yes
No
Required
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