Join NPCA - Founder Level

This level is for those interested in investing in the financial health and sustainability of NCPA.

Prefix

First Name *

Last Name *

County of Residence (for internal use only) *

Address *

Street Address

City

State

Country

Postal Code

Email *

Always use the SAME email address when you make purchases with NPCA. This ensures that all activity is properly credited to the same account.

Highest Degree *

NC License Number *

Year Licensed in NC *

Date of birth *

Check the box to select the option you prefer: *

Membership: Founder (Auto-Renew)

When you choose the convenience of auto-renewal, your NCPA will be billed automatically to the credit card on file each year. You can change your card or cancel your auto-renewal at any time from inside your member portal.

Subscription

$975

Membership: Founder (One Year)

This option does not auto-renew. You will need to take action each year to keep your membership active.

$975

Credit Card Fee Donation

This donation offsets credit card processing fees.

$3.95

Do you want to be published in the public directory? *

Directory Image

Directory Street Address

Directory City

Directory State (Dropdown)

Directory Postal Code

Directory Phone

Directory Email

Website

Ages Served *

Assessment/Evaluations *

Issues *

Counties Served *

Foreign Language(s) Proficiency

Gender *

Ethnicity *

Licensure *

Modality

Where are you in your career? *

Practice Setting *

Religious Affiliation *

Licensed in Another State

PsyPact *

Licensed Behavior Analyst *

APA Member *

College/University *

Accepting New Patients *

Insurance Accepted *

Medicaid Accepted *

Medicare Accepted *