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How To Help

Membership

Membership application for individuals and organizations

If you are applying as an organization or sponsor member and would like to be issued an invoice please contact nebreastfeeding@gmail.com prior to submitting your application.
Your contribution is tax-deductible. 

 

Select Type of Membership
*Bronze, Silver, Gold, and Platinum Sponsor Memberships include up to 10 members

If you've selected an Organizational membership (up to 5 members) or Sponsor membership (up to 10 members) please provide the contact information of the individuals you would like to be included in the membership.

Please type members' names, emails, phone numbers.
Are you a new or renewing member?

If you're employed or go to school, please best describe your employment sector.

Select up to 2 option which best describe your employer.

Basic Demographic Information

Age:
Gender
Race/Ethnicity
Please select your credentials. What best describes your expertise?
Check all that apply.

If you've selected MD/DO, MD/DO Resident, PhD, Master's Degree or Other in the question above, please specify your specialty, major or area of work in the field below.


Potential commercial conflicts of interest
If there's a potential conflict of interest, please explain in the field below.

The coalition’s four strategic goals focus on the infrastructure of the coalition (i.e., funding, internal processes), workforce development, community breastfeeding support and breastfeeding advocacy. Are you or your organization interested in being involved in the work being conducted in any of these areas?

Areas of work
Check all that apply.
What areas of expertise could you or your organization offer the coalition?
Check all that apply.

Are you a member of a local breastfeeding coalition?
If Yes, please answer the following:
If you are not a member of a local breastfeeding coalition would you like the Nebraska Breastfeeding Coalition to help connect you to your nearest local breastfeeding coalition?

I agree to support the mission, goals and values of the Nebraska Breastfeeding Coalition. 
I attest that I have disclosed any real or potential conflicting commercial interests related to breastfeeding, lactation or associated products or services.
The Nebraska Breastfeeding Coalition reserves the right to deny or revoke membership by majority vote of the Leadership Team.

Signature
Checking this box is equivalent to a handwritten signature.
Your total payment will be

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