New Mexico Breastfeeding Task Force

2017 Annual Membership Application

As a member of the New Mexico Breastfeeding Task Force, you will be making an important contribution to improving the health status and reducing health care costs of New Mexico families through the advancement of breastfeeding.

Membership Information

Membership Period*
  • 1 Year: January 2017 - December 2017
  • 2 Year: January 2017 - December 2018
Account Type*
  • 1 year: Student/Peer Counselor $10.00
  • 1 year: Individual $20.00
  • 1 year: Non-Profit Government (includes up to 2 Members) $50.00
  • 1 year: Business (includes up to 4 Members) $100.00
  • 2 year: Student/Peer Counselor $18.00
  • 2 year: Individual $36.00
  • Emilie Sebesta Lifetime Membership Fee (individual) $500.00
Please list the names and email addresses of the additional members for a Non-Profit/Government or Business membership

Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*
County*
Name of Organization (if applicable)
Credentials*
  • IBCLC
  • CLC
  • BPC (Breastfeeding Peer Counselor)
  • CHW (Community Health Worker)
  • Nutritionist
  • Midwife
  • RN
  • CNP/NP
  • PA
  • MD/DO
  • Other
  • N/A
For data purposes, please indicate which ethnicity you identify as.*
  • White/Caucasian
  • African American
  • Hispanic
  • Native American
  • Asian American
  • More than one race/ethnicity
Are you currently a NMBTF member?*
  • Yes
  • No
Are a Chapter Officer?
  • Yes
  • No
If you are you part of a NMBTF Committee, please indicate which ones. If not, please choose N/A.*
  • Advocacy & Policy Committee
  • Baby-Friendly Hospital Committee
  • Clinical Education Committee
  • Conference Planning Committee
  • Data & Research Committee
  • Finance Committee
  • N/A

The Task Force is committed to bridging the gap in breastfeeding disparities and ensuring that all families, including people of color, LGBTQ families, immigrants, and other marginalized populations, are included in breastfeeding advocacy work.  By providing this information, you help us build an organization representative of the communities we serve.

Please read Conflict of Interest Policy here

I have read and will abide by the Task Force Conflict of Interest Policy*
  • Yes

Please note that scholarships are available.

Membership expires in December of each year.

 

Membership Benefits

  • Discounted tuition at Task Force sponsored events, including our Annual Conference and Hospitals/Clinics Summit
  • Statewide networking
  • Quarterly meetings: travel reimbursements (based on need and distance) and free child care for children (1yr and older)
  • Access to resources for lactation professions
  • Technical assistance and tool kits
  • Member-only funding/project support
  • Statewide promotion of your local breastfeeding efforts and events
  • Opportunities to contribute through committee activities
  • Regular updates regarding evidenced-based breastfeeding practices, advocacy efforts, resources, and upcoming events
  • Scholarship opportunities for IBCLC exam and renewal fees
  • Chapter leadership opportunities and professional development
  • A voice and vote in determining the future direction and focus of the New Mexico Breastfeeding Task Force

JOIN TODAY!

After you complete your membership registration, you will receive a welcome email.  

Please check your spam/junk folder if you did not receive it.

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code

Share This Form

Powered by eTapestry.