Lactation Room Registration Form

Please register for the Lactation Room Program if you use, or are planning to use, a Lactation Room. If you express milk in your office or another private location, registration is encouraged, but not required. By registering for the program, you will receive information about accessing specific Lactation Rooms (most rooms require activation of your ID and this process can take up to 24-48 hours), program updates, and information regarding new resources. Registering also helps the program administrators document the need for additional Lactation Rooms, hospital-grade pumps, and support services. To ensure your privacy, individual names will never be released as part of our reporting.
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Section Break

  • (Optional)
  • (Optional)