Gold Standard 2013 Registration

REGISTRATION FORM
Please complete the form below.

It is necessary for correct price calculations that you use the TAB key to move through the fields on this form
or click on the Total Due Field before clicking Submit.

First Name (As you want it to appear on your name badge)	*
Last Name	*
Organization
Title:
Email Address	*
Phone Number	*
Fax Number
Address	*
City	*
State	*
Zip Code	*

Please indicate your credentials by entering your Certification/License Number below.
CHES Number:		IBCLC Number: La Leche Leage Leader Area/Group:
OT Number:		RD Number: RN Number:

Number of Days Attending:
Reg Type:	*
Day(s) Attending: Do NOT mark any days if you selected Full Conference.
		Wednesday Thursday Friday
Registration Total: *

Lagniappe: Pre-Ordering books ends March 1st. After March 1, you will not be able to enter anything into the book fields.

The syllabus will be available on the website for anyone wishing to download/print a copy.
You may choose to receive a printed copy, a CD, or a flash drive for an additional fee.
Click here to indicate if you wish to receive these "extra" items.
Syllabus Options:		CD Flash Drive Printed Syllabus
Syllabus Total: *

Awareness Run/Walk
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Pre-Order Books:
A limited quantity of the books designated with an asteriisk will be available in the conference bookstore.
All other books are available by pre-order only.

Book 1: Balancing Breast and Bottle, Peterson & Harmer, $21.95 QTY:
Book 2: Best Medicine: Human Milk in the NICU; Wight, Morton, & Kim= $32.95 Qty:
Book 3: Biological Nurturing: laid Back Breastfeeding for Mothers DVD $39.95
Book 4: Breastfeeding & Diseases; Buescher, & Hatcher =$24.95 Qty:
Book 5: Breastfeeding and Human Lactation, 4th Edition; Riordan & Wambach= $124.95 Qty:
Book 6: Breastfeeding and Natural Child Spacing, The Ecology of Natural Mothering; Kippley= $14.95 QTY:
Book 7: Breastfeeding Answers Made Simple, Mohrbacher,=$79.95 QTY:
Book 8: Breastfeeding Answers Made Simple: A Pocket Guide for Helping Mothers, Mohrbacher = $37.95 Qty:
Book 9: Breastfeeding Atlas 4th Ed., Wilson-Clay=$59 QTY:
Book 10: Breastfeeding in Combat Boots, Roche-Paull=$29.95 QTY:
Book 11: Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers; Mohrbacher, Kendall-Tackett=$18.95 QTY:
Book 12: Breastfeeding Management for the Clinician: Using the Evidence, Walker=$85.95 QTY:
Book 13: Breastfeeding Mother’s Guide to Making More Milk, West=$17.95 QTY:
Book 14: Breastfeeding: A Guide for the Medical Professional, Lawrence=$96.95 QTY:
Book 15 Breastfeeding: An Illustrated Guide To Diagnosis and Treatment; Both, Frischknecht=$59.95 QTY:
Book 16: Breastfeeding: Mom and I Can Do That, DVD, Cox=$49.95 QTY:
Book 17: Breastfeeding Solutions: Quick Tips for the Most Common Nursing Challenges, Mohrbacher = $15.95 Qty:
Book 18: Clinical Therapy in Breastfeeding Patients; Hale, Berens=$29.95 QTY:
Book 19: Clinician's Triage Tool = $2.00 QTY:
Clinics in Human Lactation:
Book20: -Altering Hospital Maternity Culture: Current Evidence for the Ten Steps to Successful Breastfeeding, Cox=$18.95 QTY:
Book 21: -Breastfeeding after Breast and Nipple Procedure; West, Hirsch=$18.95 QTY:
Book 22: -Breastfeeding the Late Preterm Infant, Walker=$18.95 QTY:
Book 23: -History and Assessment: It's All in the Details, Altman=$18.95 QTY:
Book 24: -How Breastfeeding Protects Maternal Health Throughout the Lifespan=$18.95 QTY:
Book 25: -Mentoring Our Future. Altman=$18.95 QTY:
Book 26: -The Nipple and Areola in Breastfeeding and Lactation, Walker=$18.95 QTY:
Book 27: -NonPharmacologic Treatments for Depression, Kendall-Tackett=$18.95 QTY:
Book 28: Colic Solved: The Essential guide to Infant Reflux and the Care of Your Crying, Difficult-to-Soothe Baby, Vartabedian=$13.95 QTY:
Book 29: Comprehensive Lactation Consultant Exam Review, Third Edition, Smith=$78.95 QTY:
Book 30: Continuity of Care in Breastfeeding: Beast Practices in the Maternity Setting; Cadwell, Turner-Maffei=$69.95 QTY:
Book 31: Core Curriculum for the Lactation Consultant Practice, Walker=$91.95 QTY:
Book 32: Counseling the Nursing Mother, Fifth Edition A Lactation Consultant's Guide; Lauwers, Swisher=$116.95 QTY:
Book 33: Doulas' Guide to Birthing Your Way; Mallak, Bailey=$21.95 QTY:
Book 34: Hale & Hartmann's Textbook of Human Lactation; Hale, Hartmann=$89.95 QTY:
Book 35: Human Milk in the NICU: Policy into Practice, Arnold=$81.95 QTY:
Book 36: Impact of Birthing Practices on Breastfeeding, Second Edition, Smith=$66.95 QTY:
Book 37: Interaction and Relationships in Breastfeeding Families, Epstein-Gilboa=$34.95 QTY:
Book 38: Introduction to Biological Nurturing, An; Colson=$19.95 QTY:
Book 39: Keep the Fires Burning: Conquering Stress and Burnout as a Mother-baby Professional; Jones=$19.95 QTY:
Book 40: Legal & Ethical Issues for the IBCLC; Brooks=$62.95 QTY:
Book 41: New Insights into Vitamin D During Pregnancy, Lactation, & Early Infancy; Wagner, Taylor, Hollis=$24.95 QTY:
Book 42: Passionate Journey: My Unexpected Life=$19.95 QTY:
Book 43 Postpartum Depression At A Glance, Kendall-Tackett=$9.95 QTY:
Book 44: Selecting and Using Breastfeeding Tools, Watson Genna=$32.95 QTY:
Book 45: Six Mothers Six Stories of Disability; Wilson=$18.95 QTY:
Book 46: Sleeping with Your Baby, A Parent’s Guide to Cosleeping, McKenna=$14.95 QTY:
Book 47: Spanish for Breastfeeding Support; Glick, Lieberman=$39.95 QTY:
Book 48: Start Here: Breastfeeding and Infant Care with Humor and Common Sense; McCue=$17.95 QTY:
Book 49: Supporting Sucking Skills in Breastfeeding Infants, Watson-Genna=$73.95 QTY:
Book 50: Tongue Tie: Morphogenisis, Impact, Assessment and Treatment; Hazelbaker=$52.95 QTY:
Book 51: The Womanly Art of Breastfeeding=$20.00 QTY:
Book Total: *
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Lagniappe Total: *
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Please help us ensure adequate seating by clicking the button for each and every Session you plan to attend, even the General Sessions.

Are you willing to be a Session Monitor?		Yes

Wednesday, April 3, 2013

G1: 10:00 - 11:30 AM		The Natural Laws of breastfeeding, Nancy Mohrbacher

Lunch On Own

G2: 12:45 - 2:30 PM		MRSA Mastitis, Barbara Wilson-Clay
G3: 2;45 - 4:15 PM		Using the International Code, Nancy Mohrbacher
O1: 4:30 - 6:30 PM		Empty Arms, Broken Heart, Linda and Vincent McGrath.
O2: 4:30 - 6:30 PM		Peer Study Group
7:00 - 9:00 PM Dinner Around: Sign up to enjoy Dinner on Your at a local restaurant with other confernce attendees.		American Sector August Back to the Garden Cochon Butcher Drago's Emeril's Emeril's Delmonico Gordon Biersch Mother's Restaurant Mulates Sun Ray Grill Ugly Dog Saloon & BBQ

Thursday, April 4, 2013

E1: 7:00 - 8:00 AM		Diapers of the Breastfed Baby, Barbara Wilson-Clay
G4: 8:15 - 9:45 AM		Simplifying Breastfeeding: The 1st 36 Hours, Nancy Mohrbacher
Thursday Morning Breakouts (Choose ONE) 10:00 - 11:00 AM
101:		Overcoming Bias, Bethany Willis.
102:		Rights, Responsibilities, & Rewards in the Workplace and Beyond, Bianca Wooden.
103:		Societal Barriers to Breastfeeding, Maranda Nybo.
104:		Twosomes and Threesomes and Tandems, Oh My!, Pamela Helmstetter.
11:15 AM - 12:45 PM: Thursday Luncheon (Please indicate choice) and Stretch Break

While the caterer is happy to meet your needs if possible, we cannot guarantee all requests can be met.
Describe Special:
G5: 1:00 - 2:30 PM		Case Studies, Barbara Wilson-Clay
Thursday Afternoon Breakouts (Choose ONE) 2:45 - 3:45 PM
201:		Hands Heal: Bodywork Techniques to Support the Breastfeeding Relationship, Karen Broyles. (repeats as session 301)
202:		Abnormal Anatomy: Congenital & Acquired, Dr. Terry Dise.
203:		Breastfeeding and the Use of Human Milk, Dr. Farooq Abdulla.
204:		Why is the Baby Sleepy?, Barbara Wilson-Clay.
3:45 - 4:15 PM Dessert and Coffee break
G6: 4:15 - 5:45 PM		Helping Mothers Who Exclusively Pump, Nancy Mohrbacher
6:00 PM Free Time
7:00 PM Dinner: (Choose ONE)
ALL SPEAKERS Please Select - Speaker Dinner @ Tujaques!!


Friday, April 5, 2013

E2: 7:00 - 8:00 AM		The Appearance of Human Milk, Barbara Wilson-Clay
G7: 8:15 - 9:45 AM		Understanding Breastfeeding Behaviors, Nancy Mohrbacher
Friday Morning Breakouts: (Choose ONE) 10:00 - 11:00 AM
301:		Hands Heal: Bodywork Techniques to Support the Breastfeeding Relationship, Karen Broyles. (repeat of session 201)
302:		Increasing Breastfeeding Rates in Communities of Color, Toni Hill & Jimmy Hill, Jr.
303:		Communication is the Key, Lisa McAlister.
304:		Twosomes and Threesomes and Tandems: Oh My! Pamela Helmstetter. (repeat of session 104)
11:15 AM- 1:15 PM Award Luncheon with Dessert, (Indicate Choice of Meal), and Stretch Break

While the caterer is happy to meet your needs if possible, we cannot guarantee all requests can be met.
Describe Special
G8: 1:15 - 2:45 PM		Nipple Pain & Trauma, Nancy Mohrbacher
2:45 - 3:30 PM Closing Session: Evaluations/wrap up/door prizes

Breakfast Tickets: (For those not staying @ the Hampton)
#
Breakfast Total: *
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Extra Lunch Tickets:(These are IN ADDITION to the lunch ticket you will receive with your paid registration.)
Total Extra Lunch Tickets for Thursday:
Please indicate Thursday lunch choice:
# Meat
# Veg
# Fish
# Special
While the caterer is happy to meet your needs if possible, we cannot guarantee all requests can be met.
Describe Special
Total Extra Lunch Tickets for Friday:
Please indicate Friday lunch choice:
# Meat
# Veg
# Fish
# Special
While the caterer is happy to meet your needs if possible, we cannot guarantee all requests can be met.
Describe Special
Extra Lunch Total: *
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Extra Speaker Dinner Tickets: (In addition to the one which may have been ordered above on your registration)
Extra Dinner Tickets QTY:
Extra Dinner Total *
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Extras Total: *
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Subtotal: (Registration + Lagniappe + Speaker Dinner + Extras) *
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Scholarship		I received a full registration scholarship I received a reduced registration scholarship

The following may receive a discounted price:
General Public not requiring Continuing Education Units:
La Leche League Leaders
WIC Breastfeeding Peer Counselors
Students with valid ID
Select the days you are attending from the list below:
		Full Conference
		Wednesday
		Thursday
		Friday
Conference Speakers: Please indicate the days you are speaking.....
		Full Conference
		Wednesday
		Thursday
		Friday
I am a speaker and I will be attending the Speaker Dinner:		Yes
Total Due: *
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Make all checks payable to: Breastfeeding: The Gold Standard
PayPal payments may be sent to: funds@breastfeedingthegoldstandard.org
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