EmailMe Form - Associate or Affiliate Membership Invoice Request

Associate or Affiliate Membership Invoice Request

Thank you for your interest in membership with NCADV. This form is for organizations needing an invoice for joining or renewing at the NCADV Associate or Affiliate membership levels, and who are paying by check.

If you are seeking an invoice for a Single Membership with NCADV, please do not use this form. Rather, complete the form found here as our process is different for single memberships.

To review NCADV membership levels and qualifcations, please click here.

NCADV will email you within three business days from the date of the submission of this form with an invoice. Please note: your membership with NCADV will be activated when payment is received and processed by NCADV. Membership is considered active for one year from receipt of payment (e.g., June to June).

Questions? Please contact membership@ncadv.org.

Membership Main Point of Contact (for billing or questions) *
First Last
Main Point of Contact Phone: *
### - ### - ####
Main Point of Contact Email *
Organization or Company Name *
Organization's/Company's EIN or Tax ID Number: *
Organization's/Company's Website: *
Organization's/Company's Main Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Please select the membership level at which you are joining or renewing. *
Associate ($419)--for those providing direct services to victims or survivors of violence or abuse
Affiliate ($839)--for those providing other services, but not direct services, to victims and survivors of violence and abuse
Examples of direct services: crisis counseling and assistance, emergency services, legal assistance, emergency shelter, housing assistance, criminal justice support and advocacy, support groups, etc.
Please provide a listing of the direct services your organization provides to victims or survivors of violence or abuse. *
Examples of direct services: crisis counseling and assistance, emergency services, legal assistance, emergency shelter, housing assistance, criminal justice support and advocacy, support groups, etc.
Associate and Affiliate members may add up to ten (10) additional staff members to their organizational membership. Once your payment is received and your membership is processed, NCADV will email each staff person with login information to the NCADV Member Portal.

Staff Member Name Staff Member Email Address

1)

2)

3)

4)

5)

6)

7)

8)

9)

10)
Thank you for being a member of NCADV
Again, NCADV will send an invoice via email to the email address of the main point of contact listed above within three (3) business days from the date of the submission of this form.

Please note: your membership with NCADV will be activated when payment is received and processed by NCADV.

Membership is considered active for one year from receipt of payment (e.g., June to June).

If you have further questions, please email us at membership@ncadv.org

	Staff Member Name	Staff Member Email Address
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)

Thank you for being a member of NCADV