Prospective Medela Mom Mavens Survey

Yes No
Please select yes or no.

I am a mom. *

Yes No
Please select yes or no.

I used Medela breastpump(s) to express milk for feedings and had an overall positive experience with the breastpump(s). *

Yes No
Please select yes or no.

I feel comfortable about recommending nursing to other moms. *

Yes No
Please select yes or no.

I would find it rewarding to help educate other women on the health benefits of breastfeeding. *

Yes No
Please select yes or no.

I would be willing to discuss breastfeeding issues and to recommend Medela in social networks, both online and face-to-face. *

(Optional) I would like to share with you some of my personal feelings about breastfeeding and/or breastpumping:

Email Address *

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If you have a blog please include the URL here:

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Please read through the statements below. If you can answer “yes” to the statements, please submit your application to become a Medela Mom Maven.
	Yes No Please select yes or no.	I am a mom. *
	Yes No Please select yes or no.	I am currently breastfeeding or have breastfed within the past six months. *
	Yes No Please select yes or no.	I used Medela breastpump(s) to express milk for feedings and had an overall positive experience with the breastpump(s). *
	Yes No Please select yes or no.	I am comfortable speaking with other women about my breastfeeding and/or breastpumping experiences. *
	Yes No Please select yes or no.	I feel comfortable about recommending nursing to other moms. *
	Yes No Please select yes or no.	I believe women should try to exclusively provide breast milk to their babies for the first six months of their lives. *
	Yes No Please select yes or no.	I would find it rewarding to help educate other women on the health benefits of breastfeeding. *
	Yes No Please select yes or no.	I would be comfortable recommending Medela breastpumps to moms and moms-to-be. *
	Yes No Please select yes or no.	I would be willing to discuss breastfeeding issues and to recommend Medela in social networks, both online and face-to-face. *
	Yes No Please select yes or no.	I would be willing to report back to Medela about my discussions on breastfeeding, pumping and Medela products. *
		(Optional) I would like to share with you some of my personal feelings about breastfeeding and/or breastpumping:

		Your Name *
		Please type your name.
		Email Address *
		is not a valid e-mail address.
		If you have a Twitter handle and would like to add it to the Medela Mom Mavens Twitter list please enter it here:
		Invalid Input
		If you have a blog please include the URL here:
		Invalid Input

		* = required.