Conference Lactation Space Designation Application Survey

5-Star Conference Lactation Space Seal

4-Star Conference Lactation Space Seal

Conference Information:(Required.)

Name of Conference:

Organization/Entity hosting the conference:

Conference Website:

Event Date(s):

Location (Venue & City):

Primary Contact Name:

Email:

Phone Number:

4-Star Designation:

Must meet six (6) of the eight (8) criteria below:(Required.)

A private space that is not a bathroom and has a lockable door, chair, table, and accessible electrical outlet for attendees to pump. If a key is required, it is available from at least two marked locations. A photo or description of the lactation space must accompany the application.

Water and light snacks in the lactation space for breastfeeding attendees

Signage to help attendees locate the lactation space and on the lactation space door

Promotional emails communicating that a lactation space is available

Social media communicating that a lactation space is available

Registration form mentions that a lactation space is available

Program materials mentions that a lactation space is available

Day-of Announcements (e.g., slides, remarks, etc.) mention that a lactation space is available

Other (please specify)

5-Star Designation:

Must meet the 4-star criteria above plus the following:(Required.)

Access to a refrigerator for breast milk storage (e.g., a mini-fridge or access to a staff fridge)

Breastfeeding education materials and resources are available in the lactation space

Attachments:

Please provide a brief description or photo of the identified lactation space setup (location, privacy, amenities, etc.)

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