Espresso Milk Collective Pre-Registration Form
Once you have completed the pre-registration form, you will receive a zoom link to register for the virtual Black breastfeeding support group which meet monthly on the 2nd Wednesday of each month 6p-7p.

Espresso Milk Collective was created by Your goodVillage Collective to address  racial disparities that exist in Black breastfeeding while providing a culturally safe space. If you do not meet this criteria and are interested in receiving breastfeeding support, please contact us for other resources at 888-357-2366.


*By providing your phone number, you consent to receiving automatic text messages for upcoming events and event reminders. Text HELP for info. Text STOP to quit.
Sign in to Google to save your progress. Learn more
Email *
This group was created as a safe space due to the disproportionate rates of Black maternal and infant mortality and breastfeeding disparities. Do you self identify as a person who is Black/African American? *
First and Last name *
Phone Number *
Please indicate the city in Michigan where you reside *
Are your pregnant? *
Are you currently breastfeeding? *
Please confirm that you are aware that we no longer meet twice per month.  We currently meet once per month on 2nd Wednesdays 6p-7p, *
Required
How did you hear about Your goodVillage Espresso Milk Collective? *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Your goodVillage Collective. Report Abuse
Google Forms