Interested in joining the WIC Breastfeeding Buddy Program? Fill out the form below to get started

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* 1. Participant name (first and last)

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* 2. Participant birth date

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* 3. Infant birth date or Estimate delivery date

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* 4. Phone number

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* 5. Email address

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* 6. Mailing address (street, city, state, zip code)

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* 7. Please select the clinic you visit for WIC Program services