Contact Information:

Your First Name
Your Last Name
Your E-mail
Company's Name:
Number of Employees
Contact Person's Name:
Contact Person's Title:
Contact Email:
Street Address:
City:
State:
Zip:
Contact Phone:
Contact Fax (if any):

Where did you hear about Breastfeeding Works?

Task Force  Employer/Employee  Coworker  Other 

Describe your “mother-friendly” or “family-friendly” program.  Describe its various components, including date of roll-out or pilot, scope of the program.

Does your program include a Lactation Room?  If so, describe the facility and the program associated with it.

Describe the effectiveness of your program (i.e., number of participants, any milestones achieved relative to decreased absenteeism, healthcare cost reductions, etc.).  Provide both measurable and anectodal benefits and results.

Include testimonials, if available.

Please contact me as soon as possible regarding this matter.