ILCA Volunteer Application Professional Development

ILCA Volunteer Application

Thank you for your interest in volunteering for ILCA! Please complete this application and submit with a copy of your CV or résumé.

ILCA Committees

Clear Selection

Personal Information

Name *
Credentials
Street Address *
City *
State/Province
Postal/Zip Code
Country *
Email Address *
Phone
Languages Spoken

Experience and Qualifications

Primary role in the lactation field
IBCLC re-certification year
I would like to volunteer at ILCA to:
In which areas do you have skills and/or experience? (For example: current/previous volunteer work)
How would you like to use your skills to serve ILCA in a volunteer capacity? Please be as specific as possible.
What is your availability? (For example, "one hour a week")

Conflict of Interest

State any potential conflict of interest

I hereby certify that I personally subscribe without reservation to the Statement of Purpose of ILCA as found in its By-laws. I will disclose, in writing and before my appointment or election, any real, perceived or potential conflict of interest. A conflict of interest arises when I am in a position to influence a decision at ILCA that will result in personal or professional gain for me or a family member. Any undisclosed conflict found after I assume my position may result in a request for resignation. Further, I subscribe without reservation to the Fundamental Principles of ILCA as found in its By-laws. I will not accept any funding from entities that are not in compliance with the WHO Code of Marketing of Breast-milk Substitutes and its subsequent WHA resolutions, nor will I use my official ILCA capacity to endorse any literature or product.

 

Enter your name below, to serve as your electronic signature.

Applicant Signature *
Date
Required Attachment: Curriculum vitae or resume *



Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

2020 Copyright - International Lactation Consultant Association