* 1. First Name

* 2. Last Name

* 3. Please let us know any credentials that you may have.

* 4. Affiliation/Employer

* 5. Street Address

* 6. City

* 7. County

* 8. State

* 9. Zip Code

* 10. Office Telephone Number

* 11. Mobile Telephone Number

* 12. E-mail Address

* 13. Please tell us how you found out about today's educational event.

* 14. Are you involved in the efforts of the Metro KC Breastfeeding Collaborative?

* 15. If you do not participate in the Collaborative, but would like information about how to become involved, please contact Paul Cesare at 816-283-MCHC (6242), ext. 239 or pcesare@mchc.net

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