EmailMeForm
NCADV Individual Membership Application
Thank you for your interest in NCADV membership.
Individual Applicants:
Individual memberships with NCADV are available to individuals interested in learning more about the issue of domestic violence and who are
not employed
by an entity or organization otherwise able to afford an organizational membership with NCADV.
Organizational Applicants with Annual Organizational Income of Less than $250,000:
NCADV will consider individual memberships for direct service providers with total annual incomes of $250,000 or less.
(If your organization's total annual income is
more
than this amount, you must
apply at the Associate Member Level.
) Organizational Memberships granted at the individual level are limited to one individual only. Please note, your organization's website, a listing of direct services provided and your organization's most recent operating budget (no older than 2020) will be required to be considered for this membership level.
Please complete all fields below.
Please allow NCADV up to three business days from the date of submission to process this application before inquiring about your application status.
If approved, you will then be emailed with a payment link for membership and can continue with membership registration then.
Questions? Please contact membership@ncadv.org.
Name
*
First
Last
Phone
###
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###
-
####
Email
*
Organization
*
Enter "None" if not associated with an organization or entity.
Organization's website:
*
Enter "None" if you are not associated with an organization or entity.
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
If you are applying as a direct service provider with a total annual organizational income of less than $250,000 a year, please list the direct services you provide to victims or survivors of violence:
*
Enter "None" if you are not associated with an organization or entity.
If you are applying as a direct service provider with a total annual organizational income of less than $250,000 a year, upload your organization most recent operating budget (no older than 2020) here:
*
If you are not associated with an organization or entity, upload any PDF or DOC file.
If granted an individual membership with NCADV, I consent to/attest to the following:
*
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.