EmailMeForm
Multiple 2025 FLCA Memberships
Please complete this form when paying membership online. Becoming a member takes two steps. Filling out a membership form AND submitting payment.
Every member is added to:
* The FLCA Members Registry in the "Members Only" section on our website
* Email Listserv
* FLCA Data base kept by the FLCA Treasurer and Membership Secretary
Name
*
First
Last
Check all that apply:
*
ARNP
CLC
Dietitian
Doula
IBCLC
La Leche League Leader
Licensed Practical Nurse
MD or DO
Midwife
OT
Physicians Assistant
Registered Nurse-hospial based
Registered Nurse-non-hospital based
SLP
WIC Breastfeeding Coordinator
WIC Peer Counselor
Other
IBCLC Number if Applicable (if not applicable put NA)
*
Home Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Preferred Email
*
Home or Cell Phone
*
###
-
###
-
####
Check all that apply
*
First time FLCA Member
Renewing FLCA Member (member in 2024)
Previous FLCA Member
ILCA Member
USLCA Member
Passing exam first time (2024)
Ethnicity/Race
*
Asian/Pacific
American Native
Black or Africian American
Hispanic
White
Other
Prefer to not disclose
Name
First
Last
Check all that apply:
*
ARNP
CLC
Dietitian
Doula
IBCLC
La Leche League Leader
Licensed Practical Nurse
MD or DO
Midwife
OT
Physicians Assistant
Registered Nurse-hospial based
Registered Nurse-non-hospital based
SLP
WIC Breastfeeding Coordinator
WIC Peer Counselor
Other
IBCLC Number if Applicable (if not applicable put NA)
*
Home Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Preferred Email
*
Home or Cell Phone
*
###
-
###
-
####
Check all that apply
*
First time FLCA Member
Renewing FLCA Member (member in 2024)
Previous FLCA Member
ILCA Member
USLCA Member
Passing exam first time (2024)
Ethnicity/Race
*
Asian/Pacific
American Native
Black or Africian American
Hispanic
White
Other
Prefer to not disclose
