*Username:
*Password:
*Confirm Password:
*First Name:
*Last Name:
Title:
Organization Name:
*Address:
*City, State, Zip:	AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
*Email:
Web Address:
Home Phone #:
Home Fax #:
Work Phone #:
Work Fax #:
Cell Phone #:
I am interested in the following issues/projects: (Hold the CTRL key to select multiple options) Advocacy/Political Action Community Outreach Fundraising & Grants Membership Breastfeeding Resource Guide publication Professional Outreach- Breastfeeding education for professionals Research & Evaluation Volunteer Coordination Website maintenance & improvement Breastfeeding & the working woman issues/worksite award Writing articles/position papers Other Other:

Sponsor - $100.00 (Business/Organization/Professional)

• Discounted rates for Coalition sponsored events
• Newsletter "Breastfeeding Update"
• A listing, as appropriate, in the "Breastfeeding Resource Guide"
• A supply of free "Breastfeeding Resource Guides" in English and Spanish
• Free CME/CEU/CERP for 1 at Coalition meetings
• A web link, as appropriate, on the SDCBC Website: www.breastfeeding.org
• Meeting announcements, minutes and periodic e-mail updates and notices

Contributing Member - $50.00 (Individuals)

• Discounted rates for Coalition sponsored events
• Newsletter "Breastfeeding Update"
• A supply of free "Breastfeeding Resource Guides" in English and Spanish
• Free CME/CEU/CERP for 1 at Coalition meetings
• Access to "Members Only" web resources, including educational meeting audio recordings and handouts
• Meeting announcements, minutes and periodic e-mail updates and notices

Friends of the Coalition - Any amount under $50.00

• Meeting announcements, minutes and periodic email updates and notices.
• Newsletter "Breastfeeding Update"

Student Member - $25.00

• Discounted rates for Coalition sponsored events
• Newsletter "Breastfeeding Update"
• Continuing Education Credits
• Network with other health professionals
• Access to evidence-based information on breastfeeding

Please choose your membership category: Sponsor Member - $100Contributing Member - $50Student Member - $25Friend of the Coalition - $50 or less
If you selected the Friends of the Coalition option, please enter an amount:  $

Pay by Credit Card

Pay by Check

Pay by Cash

Please mail your cash payment to:
SDCBC c/o AAP-CA3
3160 Camino Del Rio South, Suite 115
San Diego, CA 92108

Please make your check payable to:
San Diego County Breastfeeding Coalition (or SDCBC).

Mail check to:
SDCBC c/o AAP-CA3
3160 Camino Del Rio South, Suite 115
San Diego, CA 92108

*Credit Card Type:	Visa MasterCard
*Credit Card #:
*Expiration Date:	01 02 03 04 05 06 07 08 09 10 11 12  /  2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036
*Security Code:	What is a Security Code?

The San Diego County Breastfeeding Resource Guide (BRG) is a compilation of San Diego County breastfeeding services and resources which is distributed to mothers, families, hospitals, physicians, health clinics and other venues throughout San Diego County. If you provide lactation services, you need to be in it!

NOTE: The Board of the San Diego County Breastfeeding Coalition (SDCBC) reserves the right to edit or refuse listings deemed innapropriate by the Board.

YES, I/we would like to be listed in the next edition of the Breastfeeding Resource Guide (BRG)

Our prior listing in the BRG is correct (Review BRG English | Spanish)

Please make the following corrections to our current listing:


New listing: Maximum 7 lines/60 characters per line.
See current BRG for examples/format. (Review BRG English | Spanish)

YES, I/we would like to have a web link on the SDCBC web site. Please list title and URL address:

Title:
URL:

Join Now!

PLEASE WAIT....