NZLCA FULL MEMBERSHIP FORM

Note: available only to IBCLC Members. If you do not have an IBCLC number, please apply for an Associate Membership

Memberships are for the period January through to December. If you join in October, November or December, your membership will be effective for the following membership year, and your first ‘Staying Abreast’ newsletter will be the following February issue.

Date

IBCLC Number

First name

Last name

Country/Region

Address

Address - line 2

City

Zip / Postal code

Ethnicity

Iwi (if applicable)

Contact Number

Alternative contact number

Confirm Email

Workplace position

employed

self-employed

Membership type

NZLCA FULL MEMBER

Per annum100

Donation option

I would like to make a donation to the NZLCA Education Fund (amounts over $5 are tax deductible)

100

Payment Details

Prices are in NZ dollars and include GST.

Note: you are not a member until your payment appears on our bank statement. TAX INVOICE: GST NO. 60 561 222.

If you are a Financial Member of ILCA (International Lactation Consultant Association) please enter that membership number below.

Select if you DO NOT AGREE to your name and contact details being given to other IBCLCs and also to organisations approved by NZLCA Board.