Membership Application

(please complete all items you feel are relevant - only those with an asterisk are required)

Personal Information
Name and/or Legal Entity (if any)
Name and/or Legal Entity (if any)
Primary Residence *
Primary Residence
Home Phone
Home Phone
Mobile Phone
Mobile Phone
Business Phone
Business Phone
Mailing/Billing Address
Mailing/Billing Address
If different from above
Joint Member's Information (if any)
Joint Member Name (if any)
Joint Member Name (if any)
Home Phone
Home Phone
Mobile Phone
Mobile Phone
Business Phone
Business Phone
Membership Contribution
(Pro-rated through the remainder of 2015)
Membership Contribution *
Payment can be made by clicking the credit card link below or by mailing a check to the Hilton Head Institute, P.O. Box 22616, Hilton Head Island, SC 29925. Membership is contingent upon approval by the Institute, which approval shall be in the Institutes’s sole and absolute discretion. If the undersigned is approved for membership, the membership dues as shown shall be due and payable no later than within thirty (30) days of approval, or upon attendance of a program or event presented by the Institute, whichever is earlier.
Tax Implications *
The Hilton Head Institute is a 501(c)(3) charity registered in the State of South Carolina. Some contributions may be tax-deductible. If you receive a financial or economic benefit in return for making a gift, the contribution is not tax deductive except to the extent that it exceeds the fair market value of the benefit. The Institute provides this information for your convenience. As always, consult your own tax or financial advisor before making personal financial decisions.
I understand that my membership privileges are conditioned upon my payment of the required membership contribution, fees and charges established by the Institute from time to time. Membership in the Institute permits me to attend by-invitation-only events and programs presented by the Institute. Members are not entitled to vote or participate in the management of the Institute and are not entitled to membership as defined in the South Carolina Nonprofit Corporation Act. Hilton Head Institute does not have a members as defined under the South Carolina Nonprofit Corporation Act. The Institute reserves the right, in its sole discretion, to reserve memberships, to terminate or modify the Membership Plan, to discontinue any or all of its operations, and to make any other changes in the terms and conditions of the Membership Plan. I understand that the final acceptance for membership with the Hilton Head Institute is subject to payment of the required membership dues.
Date *
Date

By submitting this form, I (we) understand that acceptance for membership with the Hilton Head Institute is subject to payment of the required membership contribution and charges.