EmailMe Form - NCADV Single Membership App- updated 6.24.22

Thank you for your interest in NCADV membership. To see the benefits of membership, please visit this link.

NCADV extends the yearly member rate of $119 to those who qualify as follows:

— Individuals with a personal interest in the issue and NCADV that are not employed by an entity that would otherwise qualify at the Associate or Affiliate Membership levels.*

— Individuals working for government or military agencies serving victims of violence whose agencies are prohibited from joining at the Associate or Affiliate Membership levels.

— Organizations providing direct services to victims or survivors of violence with annual organizational incomes of less than $250,000 per year. Your current year's approved operating budget must be provided to qualify.

Joining at this rate means you agree to not share your login information or NCADV member information with anyone else.

*If you have extenuating circumstances to this, please describe them in "other" below. NCADV will review internally and respond to your request.

Following the completion of this form, you will be directed to payment options or another page depending upon your responses.

Please allow NCADV up to one business week from the date of submission to process this application before inquiring about your application status.

Questions? Please contact membership@thehotline.org.

Name *
First Last
Phone
### - ### - ####
Email *
I am applying as: *
An individual with a personal interest in the issue and NCADV that is not employed by an entity that would otherwise qualify at the Associate or Affiliate Membership levels.
An individual working within a government or military agency serving victims of violence whose agency is prohibited from joining at the Associate or Affiliate Membership levels.
An organization providing direct services to victims or survivors of violence with an annual organizational income of less than $250,000 per year.
Other
Organization's Name *
Organization's website: *
List the direct services you provide to victims and survivors of violence: *
What is your organization's total annual income? *
Upload your organization's current, approved operating budget. *
Alternative files to your current approved operating budget will not be accepted. Questions? Contact membership@thehotline.org before completing this form.
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

By joining at this level: *

	Agree
I will not share my member login information with others.
I will not share the information I access via NCADV membership with others.
I understand that if I breach these terms my membership with NCADV will be immediately terminated without refund.

Individual payment options (you will be redirected to another page based on your payment choice) *
I need an invoice to pay via check
I would like to pay online
Organization <$250k payment options (you will be redirected to another page based on your payment choice) *
I need an invoice to pay via check
I would like to pay online