EmailMe Form - Membership Invoice Request

Membership Invoice Request

Thank you for your interest in membership* with the Hotline. This form is for those seeking an invoice to pay by check for membership.

To review membership levels and benefits, please click here.

The Hotline Membership Team will email you with an invoice within one business week from the date of the submission of this form.

Please note: Your membership with the Hotline will be activated when payment is processed by us. Membership is considered active for one year from receipt of payment (e.g., June to June). Membership with the Hotline is non-refundable.

Questions? Please contact membership@thehotline.org.

*Membership is a former program of NCADV.

Membership Main Point of Contact (for emails, billing or questions) *
First Last
Main Point of Contact Phone: *
### - ### - ####
Main Point of Contact Email *
Please select the membership level at which you are joining or renewing. *
Individual Membership ($119): Individuals with a personal interest in the issue that are not employed by an entity that would otherwise qualify at the Associate or Affiliate membership levels.
Associate Membership ($419/year): for those providing direct services to victims or survivors of violence or abuse.
Affiliate Membership ($839/year): 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.
Organization or Company Name *
Organization's/Company's Website: *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
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, the Membership Team will email each staff person with login information to the Member Portal.

Staff Member Name Staff Member Email Address

1)

2)

3)

4)

5)

6)

7)

8)

9)

10)
By joining at the Individual level with the Hotline, I attest to/consent to the following: *
I will not share my member login information or the information I access via Hotline membership with others. I understand that if I breach these terms my membership will be immediately terminated without refund.
Thank you for being a member of the Hotline!
The Hotline Membership Team will send an invoice to the email address of the main point of contact listed above within one business week from the date of the submission of this form.

Please note: Your membership with the Hotline will be activated when payment is processed by us.

Membership is considered active for one year from receipt of payment (e.g., June to June). Membership with the Hotline is non-refundable.

If you have further questions, please email us at membership@thehotline.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 the Hotline!