Membership Application and Renewal for CACs Membership Signup and Renewal Name of Center* Address* Street Address Address Line 2 City ZIP Code Your Name* First Last Title* Phone (Work)*Phone (Mobile)*FaxPhone (Emergency)*Email* Website* Your CAC's Facebook page URL Your CAC's Twitter handle Briefly describe how your Child Advocacy Center meets the ten NCA Standards:Multidisciplinary Team:*Cultural Competency and Diversity:*Forensic Interviews:*Victim Support and Advocacy:*Medical Evaluation:*Mental Health:*Case Review:*Case Tracking:*Organizational Capacity:*Child-Focused Environment:*Corollary Services:*Ex: Body Safety Program, Stewards of ChildrenStrengths your CAC can bring to the Chapter:*Number of forensics interviews provided in 2019:*National Children’s Alliance (NCA) Membership Status:* Affiliate Associate/Development Accredited Non-Member Agency* Your Dues Total* I would like to pay...* Online (includes processing fee) By check/mail If paying by check/mail, an invoice with instructions for payment will be emailed to you after submitting this application.Total Due Price: $0.00 Total Due Price: $0.00 Credit CardCard Details Cardholder Name Electronic Signature* By electronically signing and submitting this document, you are affirming your authority to submit this application on behalf of your Center and that everything stated herein is true and accurate to the best of your knowledge.Date* MM slash DD slash YYYY
