For more information about the May 5th CBC Conference in San Diego contact:
Town and Country Resort
500 Hotel Circle North
San Diego, CA 92108
Click here for printable brochure and registration forms.
There are two registration forms that must be filled out and sent to two different people:
The first is a general registration form that will include a payment. The second is the questionnaire regarding the Train the Trainer Workshop. PROGRAM
10:00AM-12:00PM Coalition Building, Advocacy and Media, USBC National Coalition Meeting report,
Breastfeeding Walk and Workplace Awards with PowerPoint presentation and anAwards Celebration12:00PM-1:00PM Lunch on your own.
1:00PM-3:00PM Part 1 Lactation Support in the Workplace: Train the Trainer Workshop (by CBC with
support from DHHS MCHB/HRSA/OWH and CWA3:00PM-3:30PM Networking Break
3:30PM-5:30PM Part 2 Lactation Support in the Workplace: Train the Trainer
5:30PM-6:00PM Possible guest speaker and Coalition Action Plan Development
Everyone is welcome to participate regardless of whether they have workplace activities in place.
An unlimited number of participants may come from each coalition.
•Registration is $35 per person.
Registration is $35 per person.•Make checks payable to CWA/CBC.
Make checks payable to CWA/CBC. •MAIL to Sue Wirth, 908 Curtis Street, Albany, CA 94706-2108
MAIL to Sue Wirth, 908 Curtis Street, Albany, CA 94706-2108 •There are no FAX or phone registration available.
There are no FAX or phone registration available.•Registrations must be postmarked by April 18, 2008.
Registrations must be postmarked by April 18, 2008.•Include a legible email address for registration confirmation.
Include a legible email address for registration confirmation.•Contact Sue Wirth at Sue7211@aol.com with questions.
Contact Sue Wirth at Sue7211@aol.com with questions.CBC REGISTRATION FORM PLEASE PRINT CLEARLY
Name________________________________________________________________________
Address_______________________________________________________________________
City, State, Zip_________________________________________________________________
E-mail________________________________________________________________________
Phone (H) _________________________________(W)________________________________
Special Needs Request__________________________________________________________
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
California Breastfeeding Coalition
Application to Participate
Lactation Support in the Workplace
Train-the-Trainer Training
Please return completed forms by e-mail to EMILY4768@aol.com by April 18, 2008.
Coalition Name________________________________________________________________
Coalition Email________________________________________________________________
Contact Person_________________________________________________________________
Contact Person Address_________________________________________________________
City, State, Zipcode_____________________________________________________________
Email__________________________________Phone_________________________________
1.Does your Coalition have a Strategic Plan? If YES, does it include outreach to businesses to establish and maintain lactation support programs?
Does your Coalition have a Strategic Plan? If YES, does it include outreach to businesses to establish and maintain lactation support programs?2.Have you already developed contacts with the business community?
Have you already developed contacts with the business community? If so, please provide names of businesses:
3.Does your Coalition have a regular Employer Recognition Program?
Does your Coalition have a regular Employer Recognition Program?4.Has your Coalition developed materials for outreach activities to businesses?
Has your Coalition developed materials for outreach activities to businesses?If so, please include a sample with your application.
5.What areas of the state does your coalition cover (cities, counties) and in what areas would you target businesses for outreach activities?
What areas of the state does your coalition cover (cities, counties) and in what areas would you target businesses for outreach activities?6.Why do you want to participate in this training and how will you use the information and training you receive?
Why do you want to participate in this training and how will you use the information and training you receive?7.Which organizations are represented in your coalition who would partner with you and provide support in targeting businesses for lactation support?
Which organizations are represented in your coalition who would partner with you and provide support in targeting businesses for lactation support?8.Do you have or could you find financial or in-kind support for this initiative?
Do you have or could you find financial or in-kind support for this initiative?9.Will your Coalition be able to undertake the responsibility of training others in your coalition after the conference, and participate in post-training activities, including receiving technical assistance and monitoring?
Will your Coalition be able to undertake the responsibility of training others in your coalition after the conference, and participate in post-training activities, including receiving technical assistance and monitoring?Please provide the following information for each person attending:
Name________________________________________________________________________
Address___________________________________City, Zip code________________________
E-mail____________________________________Phone ______________________________
California Breastfeeding Coalition Conference- Monday, May 5, 2008
California Breastfeeding Coalition
Working Together For A Healthier California
California
Breastfeeding
Coalition
