PROFORMA FOR SUBMISSION OF

WORLD BREASTFEEDING WEEK CELEBRATION REPORT

Theme for 2013: “Breastfeeding Support: Close to Mothers”

THE ELECTRONIC REPORT SHOULD BE COMPLETED DIGITALLY IN THE BELOW DETAILED FORMAT AND SUBMITTED ON A CD / DVD TO THE CENTRAL OFFICE ON OR BEFORE 30TH NOVEMBER 2013

NAME OF THE BRANCH : ______

WBW’ CELEBRATION PERIOD: from ______to ______

OFFICE BEARERS DURING : President: ______

THE PERIOD UNDER REPORT:

Secretary: ______

Treasurer: ______

MEMBERSHIP STRENGTH TOTAL: ______

i)  Fellow ______

ii)  Life ______

iii)  Associate Life ______

iv)  Student ______

v)  Ordinary ______

vi)  Associate ______

vii)  Membership list enclosed Word document / Excel worksheet

(Mandatory)

ACTIVITIES PERFORMED DURING WBW

·  List 10 or less activities / programs done during WBW, mentioning the venue and co hosts

1) ______

Venue: ______Co host ______

2) ______

Venue: ______Co host ______

3) ______

Venue: ______Co host ______

4) ______

Venue: ______Co host ______

5) ______

Venue: ______Co host ______

6) ______

Venue: ______Co host ______

7) ______

Venue: ______Co host ______

8) ______

Venue: ______Co host ______

9) ______

Venue: ______Co host ______

10) ______

Venue: ______Co host ______

·  Tick (Left blank) the participation of following categories of individuals in the programs, mentioning names where relevant

___ Medical College ______

___HOD of Pediatrics / Neonatology ______

___Members of branch of IAP ______

___Central IAP Office bearers / Executive Board members ______

___IAP State Branch office bearers ______

___Paramedical personnel ______

___Local Community Leaders ______

___Members / Groups of the Lay community ______

___Government / NGO / Other organizations / Sponsors ______

·  Write a half page report on the best 5 activities / programs. Corroborate with two photographs for each activity-

·  Write a half page comment on the most important achievement during the celebration of WBW.

DECLARATION

It is certified that the information provided in the report is true to the best of my knowledge and belief.

Date: (Signature of the Secretary)

Place: Name: