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Quarterly Network Meeting Evaluation (September 2019)
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First and Last Name
(Required.)
Email
By providing your email, you agree to subscribe to notifications from MIBFN via email including newsletters and updates from Michigan Breastfeeding Network.
(Required.)
What type of organization do you work for?
(Required.)
Hospital
Prenatal Clinic
Pediatric Clinic
State Health Department
Local Heath Department
WIC
Home Visitor
Community/Grassroots
Private Lactation Services
Other
Other (please specify)
What is your primary function at your organization?
(Required.)
Physician/Medical Provider
Nurse
Breastfeeding Services
Administrator
Nutrition Services
Child Birth Support
Social Work
Physical Therapy
Occupational Therapy
Coalition Leadership
Other
Other (please specify)
Race/Ethnic Identification
(Required.)
White or Caucasian
Black or African American
Hispanic or Latino
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Other
Do not wish to disclose
Would you like to receive continuing education CERPs and/or a Certificate of Attendance for today's meeting?
Yes
No
