NCAPCS School Membership Form

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Section

School *

County

School Effective Date

School Code

Year

Title Title

School Description

(Maximum 100 words.)

Section

Address *

City *

State *

Zip *

First Name *

Last Name *

Phone Number *

Email Address *

School Logo

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Payment

Payment Method *

Credit Card

eCheck / ACH

Mail a Check

School ADM

Membership Rate

Would you like to enroll in annual recurring billing? *

Yes, we would like to benefit from annual recurring billing.

No, we prefer to make a one-time payment.

Membership Start

Membership Expires

Membership Dues

Credit Card *

Credit Card

Please have your check delivered to the following address no later than 10 business days from the date you receive your invoice:

North Carolina Association for Public Charter Schools
242 West Millbrook Road
Raleigh, NC 27609

You will receive your invoice within 2 business days.

You will receive an emailed invoice within one business day. You will find a Pay Now link at the bottom of the email that will allow you to make your payment online. Select ACH in the online form to enter your information and submit payment. Please submit payment no more than 10 business days from the date you received the invoice.

Acknowledgement *

We have read and understand the school membership information and terms as shown on ncpubliccharters.org/join-us/school-membership/

Authorization of Annual Recurring Billing *

We authorize the North Carolina Association for Public Charter Schools to automatically bill annually the card/account specified on this form in the amount indicated on this form for the purpose of school membership dues. Any changes to the membership fee structure will be sent to us at least 60 days prior to our next billing and will be applied to our next billing cycle. If we choose to cancel our membership or at least cancel recurring payments, we must express that in writing by emailing josh@ncpubliccharters.org.

Signature *

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NCAPCS School Membership Form

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Section

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