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Global Partner Profile

Thank you for your interest in becoming an ILCA Global Partner. In order to process your partnership request, certain information about your organization is needed. You are requested to complete the following Global Partner Profile.
 
After your submission, Meredith Parker, ILCA Assistant to the Executive Director, will be in touch regarding next steps.
 
Please note that all information collected will be used by ILCA Staff and volunteers to evaluate partner profiles and contact applicants.
 
If you have any questions, please feel free to email Meredith at admin@ilca.org.

Contact Information

1. Organization's Legal Name *
2. Please describe the region covered by your organization: *
3. Website

4. Mailing Address

Address Line 1 *
Address Line 2
Address Line 3
City *
State/Province
Postal/Zip Code
Country *

5. Primary Point of Contact

First Name/Given Name/Forename *
Last Name/Family Name/Surname *
Email Address *
Primary Phone (with Country Code) *
Secondary Phone (with Country Code)

6. Secondary Point of Contact

First Name/Given Name/Forename
Last Name/Family Name/Surname
Email Address
Primary Phone (with Country Code)
Secondary Phone (with Country Code)

Organizational Information

7. Organization Type *

Clear Selection
8. Total Number of Members: *
9. Total Number of IBCLCs: *
10. Predominant Written Language: *
11. Primary Spoken Language: *
12. Please list up to 5 Core Values/Areas of Focus of your organization: *
(Maximum characters: 2000)
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13. Please describe the Vision of your organization: *
(Maximum characters: 2000)
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14. Please describe the Mission of your organization: *
(Maximum characters: 2000)
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15. Do you conduct periodic conferences? *

Clear Selection
16. Do you conduct commercial sales of products or services? *

Clear Selection
17. Are you part of a corporation (a family of companies)? *

Clear Selection

If your answer to the above question is "Yes," please proceed to question 18.

If your answer to the above question is "No," please skip question 18 and proceed to question 19.

18. If Yes, do all members of the corporation meet the requirements under the WHO International Code of Marketing of Breast Milk Substitutes and subsequent relevant WHA resolutions?

Clear Selection
19. Do you exchange funds (accept from or contribute to) with any organization that is not meeting their requirements under the WHO International Code of Marketing of Breast Milk Substitutes and subsequent relevant WHA resolutions? *

Clear Selection



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