Black Breastfeeding Week Scholarship Request Form

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NJ's 3rd Annual Black Breastfeeding Week is going digital this year! The event will run from August 25-31 with different events, workshops and activities each day. We are asking for a $5.00 donation to attend our event. There are also fees associated with some programs including infant CPR and Infant massage classes. If you need financial assistance please complete the form below and we will be in touch

Email *

First Name *

Last Name *

Email *

Phone Number *

City *

State *

I need assistance with: (select all that apply) Sorry-Infant CPR is filled *

General admission fee

Infant Massage (Regularly $50)

Required

I am in need of the following postpartum items:

My baby is in need of the follow items

Infant Gender

Female

Male

Clear selection

Infant Size

Submit

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