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Lactation Referral

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National Lactation Referral Registration Form

If you are a Hospital, Clinic, or Lactation Professional and offer a Breastfeeding Class, or Lactation Consulting, please complete the registration form below and pay $20 yearly registration fee online upon form completion.

Please fill out the following information:

Name, Hospital or Clinic 
Address
City
State/Zip
Telephone
E-mail
Credentials CLE, IBCLC   CLC   IBCLC
Others
  
Please write a brief description of what you offer:
 
Please contact me as soon as possible regarding this matter.

 

 

 

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