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.
Email address *
Name: *
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
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