MLC Registration and Terms of Use Agreement

Name*
Telephone*
Email*
example@example.com
If you are registering with a group, please note your group's information here.
If you do not know your groups ID/Name, please email: mlc@globalmilcom.org
Military Installation/Community or geographic location*
Military personal affiliation (please check all that apply)*

Service memberSpouse/partner of active duty servicememberSpouse/partner of a retired servicememberOther DOD ID-cardholder (GS civilian, contractor, etc)RetireeNonePrefer not to answer
Military service branch affiliation*

ArmyAir ForceNavyMarinesCoast GuardUniformed Service (Public Health Command, NOAA, etc)NonePrefer not to answer
Military component affiliation*

Active DutyReserveNational GuardNonePrefer not to answer
Are you a DOD ID-Cardholder?*

YesNo
- As a DOD ID cardholder, you qualify for a discount on your MLC enrollment fee. Please click the box below to acknowledge the terms of equity pricing:
  
  1. I will report any change in DOD status to mlc@globalmilcom.org within 30 days.
  
  2. Any false statements regarding my DOD status are a violation of federal law and the MLC Code of Ethical Conduct and will result in the immediate termination of my eligibility to become an MLC and revocation of certification if it has already been conferred. No refunds will be issued, and I will be liable for additional fees if it is determined that I knowingly misrepresented my eligibility for equity pricing.
  
  Please allow up to 3 business days to receive an email with your discount code.
- Equity Pricing*
  
  I affirm that I am a DOD ID-cardholder, and I agree to these terms.
- Are you an onborading, current, or past volunteer with the organization?*
  
  Yes, Onboarding VolunteerYes, Current VolunteerNo
- Current Volunteer Position (Chapter Leader, Global MilCom volunteer, Admin, etc)*
- Current Chapter you volunteer with *
- Previous Volunteer Position (Chapter Leader, Global MilCom volunteer, Admin, etc)*
- Previous chapter affiliation*
- Most recent year that you volunteered with Global MilCom*
- As a former volunteer, you may qualify for an enrollment discount! Please let us know if you would like us to review your information for a potential discount of if you'd rather get started right away!
  
  I would like to see if I'm eligible to receive a discount.I'm ready to get started and want to enroll right away! I understand that if I choose to enroll immediately, I forfeit any claim to a discount based on previous volunteer involvement with Global Military Lactation Community.
- Please select which type of position you are onboarding to fill.*
  
  I will be volunteering with an existing chapter.I will be volunteering in an administrative capacity for Global Military Lactation Community (NOT associated with a specific chapter).I will be starting a new Global MilCom Chapter.
- Existing Volunteer Position (Chapter Manager, Global MilCom volunteer, Admin, etc) *
- Existing Chapter you will volunteer with*
- New Chapter Volunteer Position (Ambassador, Program/Finance/Outreach/Membership or Education Manager, GLobal MilCom volunteer, Admin, etc) and the location/military installation/community you would like to serve .*
- New Chapter location/military installation/community you would like to serve .*
- New Chapter Volunteer Commitment*
  
  I confirm that I have spoken with the Global MilCom Director of Operations (volunteer@globalmilcom.org), have completed my orientation/onboarding, and agree to volunteer with the new chapter/global admin for at least one year .
- Are you interested in volunteering with the organization?
  
  Yes, I will contact volunteer@globalmilcom.org to start the process!No thanks. I wish to proceed with my enrollment and understand that I will not be entitled to an enrollment refund of any amount if later choose to volunteer with the organization.
- Lactation Credentials
- Do you possess any prior Lactation Credentials?*
  
  YesNo
- Please list all lactation credentials you currently hold and the dates obtained*
  Credential Date obtained
- Lactation Credential Date of expiration*
  
  MonthDayYear
  Date
- Do you want to complete the full MiLC course or would you prefer to complete the course for CERPs only at a discounted rate?*
  
  I would like to complete the full MiLC certification course.I would like to complete the course for CERPs only.
- Please upload your most recent lactation credential certificate for review. *
  
  Browse Files
  
  Cancelof
- Prior Lactation Credentials?*
  
  YesNo
- Please list all lactation credentials you currently hold and the dates obtained*
  Credential Date obtained
- Lactation Credential Date of expiration
  
  MonthDayYear
  Date
- Do you want to obtain the MiLC at a discounted rate and CERPs, or do you wish ONLY to volunteer with GLobal MilCom with your existing lactation training? (1-hour free Military Breastfeeding training will be provided to you).
  
  Yes, I want to become a MiLC and receive CERPs at a discounted rate.I only want to receive the Military Breastfeeding training (1 free CERP)
- Volunteer pricing*
  
  I affirm that I am currently a volunteer with the organization.I affirm that I am onboarding as a volunteer with the organization. I understand that I must fulfill my volunteer obligations or I will forfeit the volunteer enrollment rate. If I am starting a new chapter, I understand that it must be fully operational prior to me completing my MiLC course or I will forfeit the volunteer rate.
- Volunteer pricing*
  
  I affirm that I am currently a volunteer with the organizationI affirm that I am onboarding as a volunteer with the organization. I understand that I must fulfill my volunteer obligations or I will forfeit the volunteer enrollment rate. If I am starting a new chapter, I understand that it must be fully operational prior to me completing my MiLC course or I will forfeit the volunteer rate.
- Demographic data (optional)
  
  Global Military Lactation Community tracks aggregate demographic data of its membership, including MLCs, in order to identify gaps in our leadership representation and to provide data for applicable grant applications and national policy discussions. We ask all of our members to provide this optional data for these purposes. The Department of Defense and military families are a diverse group and we are committed to ensuring that our efforts center diversity, equity, and inclusivity. Please answer all questions according to how you self-identify, any questions may be declined by selecting "prefer not to answer."
- Race*
  
  WhiteBlackHispanic/LatinxAsian or Pacific IslanderNative American/AlaskanMultiracialPrefer not to answer
- Gender*
  
  FemaleMaleCisgenderTransgenderNon-binaryPrefer not to answerOther
- Sexual Orientation*
  
  HeterosexualLGBTQIAPrefer not to answerOther
- Languages spoken*
  
  EnglishSpanishPrefer not to answerOther
- Socioeconomic Status of servicemember in family*
  
  EnlistedOfficerGS Civilian, Contractor, or otherPrefer not to answerOther
- Education*
  
  Primary schoolHigh SchoolCollegeGraduate degreePrefer not to answerOther
- Employment*
  
  Not employedEmployed outside the homeSelf-employed/business ownerPrefer not to answerOther
- Nationality of origin*
  
  U.S.Prefer not to answerOther
- Ability*
  
  Able-bodiedDisabledSupporting a disabled or special needs family memberPrefer not to answerOther
- Intellectual Property Agreement*
  
  I acknowledge and agree to the Intellectual Property Terms of Agreement.
- Conflict of Interest Statement and Disclosure*
  
  I acknowledge and agree to the Conflict of Interest Statement
- Conflict of Interest Disclosure*
  
  I do NOT have any actual or potential conflicts of interest to disclose.I have actual or potential conflicts of interest to disclose.
- Please describe all actual or potential conflicts of interest, as defined in the COI Statement.*
- Should be Empty:

Lactation Credentials

Demographic data (optional)