Massachusetts Breastfeeding Coalition: Membership Application

Membership Application

As a member of the Massachusetts Breastfeeding Coalition you will be making an important contribution to advancing breastfeeding in Massachusetts. You can join as an individual, or as a representative of your organization.

YOUR DUES AND DONATIONS ARE TAX-DEDUCTIBLE.

Annual Membership Dues Structure (Sept.1 - Aug. 31)

Individual - $30
Non-Profit Organization - $60
For-Profit Organization - $120

Asterisk (*) Denotes required entry

* Name/Title:
Organization:
* Address 1:
Address 2:
* City:
* State:
* ZIP/Postal Code:
Country:
* Home Phone:
Work Phone:
Cell Phone:
* Email:
* Membership type:	Individual - $30 Non-Profit - $60 For-Profit - $120
* New or Renew:	New Renewal
* Please list me as a member in the next revision of the Resource Guide. Yes No * Please send me a free copy of the resource guide. Yes No In addition to my dues, I'd like to be actively involved in the MBC by: Attending Coalition meetings and sharing my expertise and experience. Contributing my time by serving on a committee.
Two payment options: Complete this form, then pay using Paypal by clicking the applicable button below, or Print this form, then mail with check payable to: Massachusetts Breastfeeding Coalition 29 Rockland Street Wellesley, Mass. 02481

For Further Information: Phone: (781) 893-3553, Fax: (781) 893-8608
Thank you for your support!

Please double check the accuracy of your email address before submitting!

Massachusetts Breastfeeding Coalition
http://massbfc.org/
254 Conant Road
Weston, MA 02493
email: info@massbfc.org
webmaster: webmaster@massbfc.org