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 is No experience, 5 is Highly Skilled

What is your current occupation? *

Employment Status*

Are you a current or former client of Mamatoto Village

YesNo

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