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How To Help

Membership

Membership application for individuals and organizations

Your contribution is tax-deductible.

Member Information
* Select Type of Membership
  • (Bronze, Silver, Gold, and Platinum Sponsor Memberships include up to 10 members)
  • Student – FREE
  • Student – optional $25 donation
  • Individual (single member) – $25
  • Organizational (up to 5 employees) – $100/year
  • Bronze Sponsor – $500/year
  • Silver Sponsor – $1,000/year
  • Gold Sponsor – $2500/year
  • Platinum Sponsor – $5000/year
* Are you a new or renewing member?
  • New Member
  • Renewing Member
* Your First Name
If you're employed or go to school, please best describe your employment sector.
Select up to 2 options which best describe your employer.
  • Health Clinic (Primary Care)
  • Hospital or Health System
  • Public Health
  • Non-profit Community Based Organization
  • Self-Employed
  • Business/Private Industry
  • Insurance Company
  • Managed Care Organization
  • Local Public Health Department
  • WIC Agency
  • Other
Basic Demographic Information
* Age
  • 18-25
  • 26-35
  • 36-45
  • 45-55
  • 56-65
  • 66+
* Gender
  • Male
  • Female
  • Other
* Race/Ethnicity
  • American Indian/Alaskan Native
  • Asian
  • Black or African American
  • Hispanic or Latino
  • Native Hawaiian or Pacific Islander
  • White
  • Other
* Please select your credentials. What best describes your expertise? (Check all that apply.)
  • Community Breastfeeding Educator (CBE)
  • Certified Lactation Counselor (CLC)
  • International Board Certified Lactation Consultant (IBCLC)
  • Registered Nurse (RN)
  • Registered Dietitian (RD)
  • Nurse Practitioner (NP)/Advanced Practice Registered Nurse (APRN)
  • MD/DO
  • MD/DO Resident
  • PhD
  • Master's Degree
  • Past or present nursing mother
  • Other
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.
* Do you have any potential commercial conflicts of interest?
  • Yes
  • No
If there's a potential conflict of interest, please explain in the field below.
Involvement in the Coalition
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? (Check all that apply.)
  • Statewide Engagement (Funding & Membership)
  • Professional Breastfeeding Workforce Development (IBCLC, CLC, MD, RD, etc)
  • Community Breastfeeding Support (mini-grants; local training and resources)
  • Breastfeeding advocacy (information shared on social media; membership)
  • Not interested
What areas of expertise could you or your organization offer the coalition? (Check all that apply.)
  • Access to breastfeeding education and information
  • Access to professional support
  • Maternity care practices
  • Peer (mom-to-mom) support programs
  • Professional education
  • Research/Grant Writing/Program Evaluation
  • Social marketing
  • Support for breastfeeding in early care and education (child care)
  • Support for breastfeeding in the workplace
  • Support for community breastfeeding efforts
* Are you a member of a local breastfeeding coalition?
  • Yes
  • No
If Yes, please answer the following:
What is the name of your local breastfeeding coalition?
How many members does your coalition have?
Are you an identified leader of the local breastfeeding coalition?
* 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?
  • Yes
  • No
Your membership amount will be $0.
Annual membership fees and donations support meeting coordination, website updates, and other communications to grow the Coalition and keep you engaged in its work. Your contribution is tax-deductible.
Signature
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.
  • Sign
* Date Signed
Type the text from the image into the space below.
Donations to Nebraska Breastfeeding Coalition are tax-deductible.
Tax-exempt status is through the UNMC Department of Pediatrics.

Nebraska Breastfeeding at a Glance

© 2019 Nebraska Breastfeeding Coalition