Individual Membership

Please print this form, provide us with the following information, and submit your membership form and a check in the amount of $25 to NCVAN. The first yearly membership for victims of violent crime is waived. We thank you for your support and look forward to you working within our network!

* Name:

Mailing Address:

Phone Number:

* Email Address:

Support Activities:

I am willing to contact my local legislators. Please contact me when my assistance is needed!

I am willing to travel to Raleigh to support NCVAN by testifying before legislative committees. Please contact me when my assistance is needed.

I am willing to volunteer my time to NCVAN events/projects. Please contact me when my assistance is needed.

I am interested in starting a local victim assistance network in my community. Please contact me to discuss this further.

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