Bloom Lactation Specialist Cohort Registration

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This form is for registration for the Bloom Lactation Specialist Cohort for the Spring/Summer 2022. Only fill out this registration form if you are registering on your own to make a payment (payment plans are available).

This form is NOT for scholarships.

Registration for the Bloom Lactation Specialist Cohort is open until March 31st. Limited spaces are available. Registration is not complete until this form is filled out and a payment is made to secure your spot (payment plans are available). If you have any questions, please do not hesitate to reach out to Tanay@BloominBaltimore.com

For more information on the cohort, visit: https://bloominbaltimore.com/events-2/

Email *

Full Name *

Pronouns *

Address (Including City, State, Zip code) *

Email *

What is your race/ethnicity? *

What is your cultural identity? What are some of your cultural traditions, practices, beliefs, etc. What is your ancestral land, lineage, what are things you celebrate? What are values of your cultural identity? Please share only a few points. *

What interests you in becoming a Certified Breastfeeding (Lactation) Specialists (CBS)? *

Please select the payment option below that best suites you. *

1 Payment of $650 (charged once)

2 Payments of $325 (charged monthly over 2 months)

4 Payments of $162.50 (charged monthly over 4 months)

6 Payments of $109.00 (charged monthly over 6 months)

Send me a copy of my responses.

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