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Project Milk Mission's 3rd Annual Mother's Day Luncheon: May 16, 2026: 12:00 p.m.- 3:00 p.m. (House Three Thirty) 532 W. Market St, Akron, 44303.
Name
*
First Name
Last Name
Date of Birth
*
Race/Ethnicity
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Please Select
White
Black or African American
Hispanic or Latino
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native
Other
Unknown
Address
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Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Status
*
Pregnant
Postpartum
Other
Due Date
-
Month
-
Day
Year
Date
Are you currently enrolled in Ohio Medicaid?
*
Yes
No
Pending
Insurance Provider?
*
Please Select
Buckeye Health Plan
Care Source
Molina Health Care
Paramount Advantage
United Health Care Community Plan
Traditional Medicaid
Other
Non-Applicable
Are you currently receiving any breastfeeding services/support?
Yes
No
Select date to attend
*
Please Select
May 16, 2026 12pm-3pm (House Three Thirty) 532 W. Market St, Akron, 44303.
How many will be attending the event with you?
How did you hear about Project Milk Mission?
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