Donate to D.C. Breastfeeding Coalition:

$

Contact Us:

Mail:
P.O. Box 29214
Washington, DC 20017

Phone:202-470-2732

Email: info@dcbfc.org

DISCLAIMER

The information presented here is not intended to diagnose health problems, breastfeeding problems, or to take the place of professional medical care. If you have persistent breastfeeding problems, or if you have further questions, please consult your health care provider. The DC Breastfeeding Coalition does not share partnership with, or have any vested interest in, any of the businesses that may appear on this site, or sites that may be assessable by links herein contained.

Business Outreach Form

We plan to do an E-mail campaign to identify businesses with interest in establishing lactation support program prior to the training so that we are able to make the best use of our efforts and energy. We will target a number of large businesses in the area as well as any that registrants are interested in approaching.

If you have businesses in mind to approach, please complete this form prior to attending the training and approaching the business. Its completion will assist outreach team members in maximizing the possibility of a successful engagement and ensure that they are included in the email campaign.

Some research may be required in order to answer each of the questions. Use the company website, call the Human Resources Department, or try other resources listed below to complete the BUSINESS INFORMATION section of the form.

Business Information
*Name of Business:
*Address:
*City:
*State: *Zip:
*Email Address:
*General Phone Number:
General Fax Number:
Website:

Contact Data for Key Decision Makers

(e.g.: Human Resources Director, Wellness Program Director, Talent Development Directors, Employee Engagement) -- TIP: Start with who you know!
*Name:
*Title:
*Email Address:
*Phone #:
Additional Information or Multiple Contacts:

Employer Characteristics

*Existing Lactation Support: (Check all that apply) None
Pump Room
Break time to express milk
Hospital-grade pump
Lactation consultant
Written policy (e.g.) break time
Paid family / maternity leave

Sector: Publicly owned for profit organization
Privately owned non-profit organization
Nonprofit organization
Government agency

Industry:
Industry Type (if applicable):

*Business Size: Small (up to 50 employees)
Medium (51-499 employees)
Large (500+ employees)

Employee Characteristics
The company employs a labor force that is approx. % female?
Approximate % of the female employees of childbearing age?

Other Information
How did you access the above information?
Other
*Please enter your name: