Visionary Membership Application

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

PRIMARY MEMBER *
PRIMARY MEMBER
Primary Address *
Primary Address
Home Phone
Home Phone
Mobile Phone
Mobile Phone
Mailing Address
Mailing Address
If different from above
Work Phone
Work Phone
JOINT MEMBER (if any)
JOINT MEMBER (if any)
Mobile Phone
Mobile Phone
Work Phone
Work Phone
Please list by Name, Title, Self/Joint Member
Visionary Membership Contribution *
Membership is contingent upon approval by the Institute, which approval shall be in the Institute's sole and absolute discretion. If the undersigned is approved for membership, the membership contribution as shown above 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 payment is not a deductible charitable contribution except to the extent that it exceeds 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. 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.
Date *
Date

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

If you are interested in a Joint or Individual Membership, please go to hiltonheadinstitute.org/membership and click on the link to Apply Online or Download an Application.