EmailMeForm
Adding Individuals to Associate & Affiliate Levels
Thank you for being a member* of the Hotline!
We appreciate you adding additional staff members to your Associate or Affiliate membership. Each person added here will have full access to the benefits of membership with the Hotline including Hotline Advochat sessions and the Hotline Member Portal as long as your organization's membership is active. To see all benefits of membership with the Hotline, please
click here.
After payment is verified for each person listed below, the Membership Team will send them an email with your organization's member number, a username, and first-time log-in instructions for Hotline’s Member Portal. This email should be received within five (5) business days from the submission of this form (please check JUNK/SPAM folders as they sometimes end up here).
Please complete the form below and list each staff person you wish to add to your membership.
If you have additional questions, please email us at
membership@thehotline.org.
Again, thank you!
*Membership is a former program of NCADV.
Organization Name
*
City in which organization is located
*
State/US Territory in which organization is located
*
Please select
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
DC
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
North Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
Point of Contact
*
First
Last
Point of Contact Email
*
Please specify your membership level
*
Please select
Associate Membership ($419/year)
Affiliate Membership ($839/year)
New or Renewing Member
New Member
Renewing Member
Current/Active Member updating information
Member Portal Access for up to ten (10) additional staff (staff must be staff of organization holding membership).
First Name
Last Name
Email Address
Staff 1
Staff 2
Staff 3
Staff 4
Staff 5
Staff 6
Staff 7
Staff 8
Staff 9
Staff 10