Breastfeeding Buddy Application Form ; Register for a Friends of Breastfeeding Buddy Your Location*CAVANCLARECORKDUBLINDONEGALGALWAYKILDARELAOISLEITRIMLIMERICKLOUTHMAYOMEATHMONAGHANOFFALYROSCOMMONTIPPERARYSLIGOWESTMEATHWEXFORDWICKLOWOTHERBaby Due Date/Birth Date* MM slash DD slash YYYY Mother Name* First Last Email Address* Contact Phone Number*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code We need it so we can Pair you with your nearest buddy.A postgraduate researcher from the Technological University of the Shannon is conducting a study titled "The Impact of Peer-to-Peer Support on Mothers' Personal Breastfeeding Goals.” The researcher is recruiting expectant mothers who plan to breastfeed and new breastfeeding mothers who have recently registered for the Friends of Breastfeeding Buddy Service to participate. Do you consent to being contacted by Friends of Breastfeeding about participating in this study?* Yes, I consent to being contacted by Friends of Breastfeeding via the email address I have provided in this form, regarding participating in this study. No, I do not want to participate in this study. Is there anything you'd like us to know to assist in pairing you with a FoBF Buddy?*Where did you hear about the Buddy System?* Friends of Breastfeeding is a registered charity CHY 19054.
