World Affairs Council Hilton Head

Membership Form Program Year July 2018 through June 2019

Last Name (Print, as you wish it to appear on your name badge) ________________________________________________________________ First Name (Print, as you wish it to appear on your name badge) ________________________________________________________________ Second member at this address (print as you wish it to appear on that name badge) Last Name ________________________ First Name _______________________ Address ________________________________ Apt. # ______ City _______________________ State _____ ZIP _________ Telephone Number ________________________ Email (please list address for each member) Email address: _______________________________________________________________ Email address: _______________________________________________________________ Membership Fee: Number of Person(s) _____ @ $100 ea. $ ________ Suggested voluntary contribution $20/member to support our Student Outreach: Model UN and Academic WorldQuest (see sheet) $ ________ Great Decisions 2019 Briefing Book (available January 2019) @ $25.00 each $ ________

Total $ ________

Please return completed form with your check (payable to WACHH) or credit card information to(below): World Affairs Council Hilton Head, PO Box 22523, Hilton Head Island, SC 29925 Credit Card #: _____________________________________Expiration date: ________________ CRV Code: _________________ Billing Zip Code: _____________________________ (WACHH Internal Use Only) Check #_____________Amt .________________ Dated _________ Rec’d ________Notes___________________________