EmailMeForm
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
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
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