* = Required information
 Registrant Information
 
*First Name:  *Phone: 
*Last Name:  Fax: 
*Your Email Address:         
*WIC Agency: 
Other Partner Org.:         
*WIC Coord.'s Email:         
NOTE: Confirmation of training details will be emailed to the registrant and the agency WIC coordinator.
 
 
        *What type of agency/organization do you work for?  
 
 
        What is your role in WIC?  (Please check all that apply)
WIC Coordinator    Certifier    Clerk   
Clerk / Certifier    Nutritionist / RD    Breastfeeding Promotion Coord.   
WIC Peer Counselor    MSS - PHN    MSS - RD   
MSS - Other    Registered Nurse    Other:  
 
        *Please describe the WIC nutrition services you provide:  
       
 


 Training Session Selection
 
 
   "Milk Made"  -  Michele Crockett, IBCLC

   *Date/Location Selection:  
 
 


 Meals
 
 
Breakfast and lunch will be provided at the breastfeeding trainings.  If you have special dietary needs, please note them below or contact WALWICA at bftrainings@walwica.org or by phone at 206-450-6139 at least 4 weeks prior to the training session.
*Meals Selection: 
 
Special Dietary Concerns: 
 
 


 
 
WALWICA
Washington Association of Local WIC Agencies
Phone: 206.450.6139         E-Mail: bftrainings@walwica.org