Kansas Breastfeeding Coalitions Conference

November 1-2, 2018
Wichita

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* 1. First Name (as it appears on your license if applicable)

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* 2. Last Name (as it appears on your license if applicable)

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* 3. Nursing License # (if applicable, for RNs, APRNs, LPNs)

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* 4. IBCLC License # (if applicable)

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* 5. Are you a WIC staff member/employee?

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* 6. Email Address

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* 7. City/Town

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* 8. County

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* 9. Name of your organization/employer (if applicable)

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* 10. For which days would you like to register?

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* 11. In which geographic region of Kansas do you reside?

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* 12. Gender

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* 13. Age

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* 14. Race

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* 15. Ethnicity

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* 16. Which of the following best describes your current occupation/place of employment?

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* 17. Do you belong to a local or regional breastfeeding coalition?

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* 18. How many times have you attended the KBC’s annual “Kansas Breastfeeding Coalitions Conference”?

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