IBC Individual Membership Form
All IBC Members agree to support the IBC’s Mission and Vision. The Indiana Breastfeeding Coalition's mission is to improve public health by making breastfeeding the norm through education, advocacy, and collaboration. The Vision is that breastfeeding is the cultural and social norm throughout Indiana. By completing and submitting this form you are acknowledging your agreement.
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Email *
Full Name *
Preferred Email *
Alternate Email
Do you want to be added to our email list? *
Company or Organization Affiliation
Are you a Lactation Professional?
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Do you have a Lactation Credential? If yes please select all that apply.
Are you interested in volunteering time? If yes, please select available time per month.
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Are you interested in volunteering resources? If yes, please explain.
Do you have any blogs, websites or social media handles that may be a resource to breastfeeding families? If yes, please list.
Does your community have any active support groups that would benefit breastfeeding families? If yes, please list.
Do we have your permission to add you as a listed resource on the Indiana Breastfeeding Coalition website?
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Are you a part of any other coalitions? If yes, please list.
Would you like information on how to become a board member?
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Would you like information on how to assist with the Terry Jo Curtis Scholarship fund?
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Today's Date: *
How did you hear about us? *
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