ROSE Training Registration Form
Select the training you are interested in attending?
*
ROSE Breastfriends
ROSE Community Transformers
Select ROSE Breastfriend Training Dates
Please Select
February 25-26, 2022 (Friday & Saturday)
April 16th & 23rd (Saturday & Saturday)
July 16th and 23rd (Saturday & Saturday)
October 14-15, 2022 (Friday & Saturday)
I am interested
Select ROSE Community Transformers Training Dates
Please Select
January 21-22, 2022 (Friday & Saturday)
March 19th & 26th, 2022 (Saturday & Saturday)
May 13 - 14, 2022 (Friday & Saturday)
September 10th & 17th, 2022 (Saturday & Saturday)
I am interested
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
APT/SUITE/ROOM Number
City
State / Province
Postal / Zip Code
How do you racially identify?
*
Hispanic/Latino
Asian
Black or African American
Native American
Hawaiian/Pacific Islander
White
Prefer Not to Say
2 or More
Highest level of education completed?
*
Some High School
High School Diploma
Some College
Associates
Bachelors
Masters and above
Prefer not to say
How did you hear about the ROSE training
*
Longest period of time you've breastfed
*
Never Breastfed
Less than 1 month
1 to 5 months
6 to 11 months
12 months or more
How would you rate your overall breastfeeding experience?
*
Extremely Negative
Negative
Neutral
Positive
Extremely Positive
Have you breastfed within the last 5 years?
*
Yes
No
Are you currently breastfeeding?
*
Yes
No
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