Lactation Specialist Training

MAMATOTO VILLAGE

LACTATION SPECIALIST TRAINING REGISTRATION

Thank you for your interest in Mamatoto Village's Lactation Specialist Training. Please complete the registration form with your non-refundable deposit. If you have any questions, please feel free to contact us at training@mamatotovillage.org.

First Name *

Last Name *

What are your pronouns? *

Birth Date *

Date

Phone Number *

Email Address *

example@example.com

Street Address *

Street Address Line 2

City *

State *

Zip Code *

Do you have children *

What is your current level of lactation experience? *

1

2

3

4

5

1 is No experience, 5 is Highly Skilled

What is your current occupation? *

Employment Status *

Are you a current or former client of Mamatoto Village

Yes No

Have you had any experience attending births and/or supporting families with lactation? (please describe) *

List any degrees, training, or certifications including dates completed. *

Do you speak any language other than English (include fluency level)? *

What goals do you wish to accomplish through the Lactation Specialist Training? *

What are your future goals? *

Do you have any food allergies, restrictions, or follow a certain dietary lifestyle? *

PAYMENT: The fee for the Lactation Training is $625 and covers training, processing fees, and session materials. You will need to pay a $300 non-refundable deposit, deducted from the total cost of the training. All remaining payments are due 6-weeks before the training. You will be invoiced for all deposits and the remaining balance.

Training Deposit *

Lactation Training Deposit

$ 300.00 Quantity

Full Training Fee

$ 625.00 Quantity

Scholarship Requested

Free

Total

$ 0.00