* = 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 / 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
 
 
  WIC Intensive Lactation Management Training
     Molly Pessl & Ginna Wall
     Evergreen Perinatal Education

    March 16-20, 2009    SeaTac, WA
 
 


 Criteria for Attendance   
 
 
Space is limited so your application / registration request does not guarantee you a spot. Your registration request will be considered and we will confirm your attendance by February 1, 2009.

This training is for local staff providing WIC Nutrition Services who have a desire to enhance the services they provide to breastfeeding moms and their babies. Understanding that space is limited to 50 participants, an application and selection process has been established for this training.

*Which criteria for attendance do you meet? (Please select all that apply.)

    Local WIC agencies participating in the Best Start Peer Counseling program and who have new staff who need to be trained in lactation management. Federal regulations require that peer counselors have regular and frequent contact with IBCLCs/trained staff.
    WIC Breastfeeding Promotion Coordinators who are not IBCLC or have not attended intensive lactation management training.
    WIC staff who will be transitioning into positions that require more breastfeeding expertise, such as the Breastfeeding Promotion Coordinator or breastfeeding lead.
    Local WIC agencies who do not currently have at least one staff person with the IBCLC designation or who were not able to send staff to the WIC Intensive Lactation Management Trainings held in 2005.
    WIC agencies who provide services in counties that have breastfeeding initiation and duration rates below the state average.
    Other WIC/MSS staff who provide breastfeeding support to clients.
 
 


 Travel Information   
 
 
Please see the travel guidelines for more information about eligibility for overnight stay. WALWICA will be sending a rooming list to the hotel; please DO NOT book a reservation at the hotel yourself.

Do you meet the 50 mile Travel Guideline?

    Yes, I am traveling a distance of 50 miles or greater, one way, from my home or clinic, whichever is closer to the DoubleTree Seattle Airport and I need to reserve a hotel room.
 
 


 Overnight & Roommate Information   
 
  NOTE: Complete only if "Yes ... I need to reserve a hotel room." was selected above.
Hotel Arrival Date:  Hotel Departure Date: 
Hotel Room Preference: 
 
   Roommate:   First Name:    Last Name: 
      Agency: 
 


 Meals
 
 
Morning coffee 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 6 weeks prior to the training session.
 
*Meal Selection: 
 
Special Dietary Concerns: 
 
 


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