Rape Crisis Center and Organization Application


  1. Complete the application and click “SUBMIT APPLICATION”
  2. Click the PayPal button to securely enter your credit card information.

Rape Crisis Centers or Organizational Memberships

Please complete and submit the following to join NCCASA or renew your NCCASA membership as a Rape Crisis Center or Organization. Completion of this form gives NCCASA express authorization to process payments using the credit card entered into PayPal.
  • Date Format: MM slash DD slash YYYY