Membership Application If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Hilton Head Civitan Club Application for Membership First Name * Last Name * Sponsors Name Employer * Mailing Address * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code * Home Phone Cell Phone * Email * Optional demographic information: Date of Birth Sex MaleFemale Marital Status MarriedSingle Spouses Name Number of Children I hereby request membership in the Hilton Head Civitan Club. Upon acceptance, I agree to be subject to its Constitution, Bylaws and official policies. I agree to pay the sum of $20 as an initiation fee and pay the regular club dues to the club, district, and Civitan International as billed by the club. I understand that $2.50 of my annual dues shall be applied as a subscription to Civitan Magazine. I Accept * By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions.