Membership Application

Personal

Full Name

Familiar Name

Date of Birth

Social Security Number

Mobile Number

Principal Place of Residence/Number/Street

City

State

Zip *

Telephone *

Unmarried Children under 23 years of age:

1. Name

Date of Birth

2. Name

Date of Birth

3. Name

Date of Birth

4. Name

Date of Birth

Business

Applicant’s Employer

Business Telephone

Occupation and/or Nature of Business

Title

Business Address

Email Address

Business Telephone

Business Address

Email Address *

Personal References

1. Name

2. Name

Address

Telephone

Years Known

*Personal references must be personal or business acquaintances whom the applicant has know for more than two (2) years. Personal references may not be family members or representatives or agents of real estate agencies selling property on Bald Head Island, Middle Island Plantation or Indigo Plantation.

Additional Information

Please indicate (a) the property at Bald Head Island or Indigo Plantation or (b) the Bald Head Island Yacht Club or Indigo Plantation Yacht Club membership number to which this membership is to be attached:

Do you own additional property on Bald Head Island and/or Indigo Plantation?

	No
	Yes

If yes, please indicate properties you own:

Are you, or have you been in the last ten (10) years, a member of any other Club(s)?

	No
	Yes

If yes, please indicate the name, address and phone number of each club, as well as a contact at that club:

I understand that membership at the Bald Head Island Club will be a membership in a private club and that acceptance for membership is subject to my being approved for membership and payment of the required purchase price and dues. I hereby authorize the disclosure and release of information for investigating my qualifications for membership, and authorize those persons and entities names herein to furnish the information.

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