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MILK Educational Program - Host Request
Please use this form to express interest in hosting the MILK Education Program. A member of our team will get back to you within 2 business days.
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* Indicates required question
Email
*
Your email
Organization Name
*
Your answer
Contact Name
*
Your answer
Title/Role
Your answer
Phone
*
Your answer
Contact Email
*
Your answer
City
*
Your answer
Province / Territory
*
Your answer
Website
Your answer
Organization Purpose
*
Choose
Breastfeeding
Food Security
Parenting Support
Health Care
Emergency Response
Other (please specify)
Provide more detail about your organizational purpose
Your answer
Would you be interested in co-hosting with another community organization?
Yes
No
Not sure
Clear selection
Please provide the name and contacts of any organizations that you would like to co-host with.
Your answer
Which format are you interested in hosting?
*
Full Program: Screening (90 min), Public Workshop (60 min) & Professional Workshop (90 min)
2-hour Program: Screening (55 min) & Public Workshop (60 min)
Virtual Program: Screening (55 min) & Public Workshop (60 min)
Professional Workshop (90 min)
Not sure
Other:
Required
Estimated attendance by audience
*
Your answer
Time of day
*
Weekday Business Hours
Weekday Evening
Weekend Daytime
Weekend Evening
Not sure
Other:
Program date
*
September 18-25
September 26-October 1
October 2-9
October 10-16
October 17-23
October 24-30
October 30-November 6
November 7-13
November 13-20
Other:
Required
If you have specific date restrictions or requirements, please note them here.
Your answer
Program Location
*
Our own location
Location within our community
Unsure/need more information
Other:
Required
Location details
Your answer
A copy of your responses will be emailed to the address you provided.
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