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 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:
Primary Mailing Address:
City, State & Zip:
Mobile Phone Number:
Work Phone Number:
Email Address: *
Company Website:
Do you rent breast pumps? *
Professional Activities:
Professional Focus:
Would you like to be listed in our Find a Lactation Consultant public BALA directory (for IBCLCs only)? *
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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