Application Forms

For payment by credit card, please download and complete both forms, print them out and fax to (919) 871-5895 or if you prefer to pay by check, please send your completed Membership Application with a check to:

NCCASA Member Services
811 Spring Forest Road, Suite 900
Raleigh, NC 27609

RCC and Organization Membership Application

Individual and Student Membership Application

Credit Card Authorization Form

Individual: $50 / year

Full-time Undergraduate Students: $25 / year

Organization or Rape Crisis Program: $150, $300, or $500 (depending on your agency’s annual budget)

  • Annual budgets <$100,000 – $150 / year
  • Annual budgets $100,000 – $500,000 – $300 / year
  • Annual budgets > $500,000 – $500 / year