Membership Application | International Lactation Consultant Association

Membership Dues

Your Dues Rate Type is: Category B Student Membership $17.00

Contact Information

Email *

Confirm email address *

Prefix

First Name *

Middle Name

Last Name *

Suffix

Title

Informal Name

Company

Mailing Address 1 *

Mailing Address 2

Mailing Address 3

City *

State/Province/Territory

Postal/Zip Code *

Country

Website

Phone Number *

Fax Number

CCMail

Include me in Membership Directories *
Yes No

Include me in Broadcast Email *
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Username/Password Username/Password

Please enter the Username/Password you would like to use to login to this website.

Your Username must be unique and must be at least 6 characters.
Passwords must be a minimum of 8 alpha-numeric characters with at least 1 number or 1 letter.

Username *

Password *

Confirm Password *

Additional Information

Institution/Course Provider *

Credentials

IBCLC? (check if yes)

IBCLC Number

Recertification Date

Select all that apply by holding down the Control key (CTRL) while clicking on each selection. Information provided below will be used only by ILCA to better understand the members it serves.

Profession/Credentials

If Other Profession/Credentials - Please Specify

Areas of Practice

Communication Preferences

Please indicate the communications you would like to receive from ILCA:

ILCA member news and membership updates via email

Journal of Human Lactation and SAGE Publication news and updates via email

Third party mailings approved by ILCA

Third party emails approved by ILCA

PLUS, I WANT TO BE AN ILCA BENEFACTOR!

You'll have the opportunity to support scholarships for those who are currently unable to access ILCA membership, which will increase knowledge for IBCLCs all over the world. All benefactors will receive recognition in the Journal of Human Lactation, the ILCA website, and on a ribbon at the ILCA conference.

If interested, please select your desired level of support below.

Category B Benefactor (Bronze) - $5.00

Category B Benefactor (Silver) - $10.00

Category B Benefactor (Gold) - $21.00

Payment Details

Discount Code

Total Amount Due

$

Payment Method

Enter the name on the bank account according to the information shown on your bank statement. The account number and routing number can be copied from the lower left corner of the check.

Account Type

Checking

Savings

Routing Number

Account Number

Account Holder Type

Business

Personal

Business Name

Account Holder Name

By submitting payment, I am authorizing International Lactation Consultant Association to initiate a single or recurring ACH/electronic debit in the amount indicated from the bank account I designated above. I understand that this Authorization will remain in full force and effect until the transaction is cancelled by me by contacting International Lactation Consultant Association, or the ACH/electronic debit is processed from the designated account. I certify that (1) I am authorized to debit the bank account above and (2) the ACH/electronic payment I am authorizing complies with all applicable laws.

Name on Card

Card Number

Expiration

CSC

Billing Street

Billing Zip Code

PO #

Save payment method for future purchases

Enable Automatic Renewals? *

Select "Yes" to enroll in automatic membership renewal. The payment method submitted with this form will be used for your future membership renewals. You can change the automatic renewal setting or saved payment method at any time in either the "Payment Methods" or "Renewal Settings" where you edit your profile.

Yes

No

Category B Student Membership Application

Membership Dues

Contact Information

Username/Password Username/Password

Additional Information

Additional Options

PLUS, I WANT TO BE AN ILCA BENEFACTOR!

Payment Details

Category B Student Membership Application

Membership Dues

Contact Information Contact Information

Username/Password Username/Password

Additional Information Additional Information

Additional Options Additional Options

PLUS, I WANT TO BE AN ILCA BENEFACTOR!

Payment Details Payment Details

Contact Information

Additional Information

Additional Options

Payment Details