Register for the Public Mothers’ Milk Bank

Volunteer form
*Required field

Personal information

Please enter your first and last names as they appear on your health insurance card from the RAMQ.

Address

Québec

ext.

If yes, please fill out our change of address form by clicking here.

*Do you participate through a PLASMAVIE?

*Date of delivery

Communication

*CONSENT FOR REGISTRATION IN THE PUBLIC MOTHERS’ MILK BANK