Humboldt State University

College of eLearning and Extended Education

Osher Lifelong Learning Institute (OLLI)
Registration Form

OLLI - Osher Lifelong Learning Institute at HSU - College of eLearning & Extended Education
Student & Business Services Building, Suite 211
(open Mon.-Fri., 8 a.m.-5 p.m.)
Humboldt State University • 1 Harpst St. • Arcata, CA 95521-8299
phone   707-826-3731 • e-mail   olli@humboldt.edu

If you do not wish to use this on-line registration form, or if you are having trouble with it, please use the downloadable form.
Fill out the form and mail it to above address.

* = Required field

PARTICIPANT Information


Please answer the following:

Male    Female
YES     NO
YES     NO
List all names you have used at HSU. (Examples: Birth Name, Maiden, Previous Marriage, Legal Name Change)
  Next 2 digits:    Last 4 digits: 
To identify your HSU record, we require you to enter your date of birth:*                      

Course Information

OLLI Members: Enter the course information for each course you want to take.

Nonmembers: Enter the course information for each course you want to take,
and include the regular course fee. By checking "Nonmember" in the Membership Status section,
a $25 per course nonmember fee will be automatically added for each course.

Class Number
Course Title/Topic

Fees*
Enter numerals only

$
$
$
$
$
 
Total Fees for Classes
$

MEMBERSHIP STATUS

Select one: *

Nonmembers: By checking "Nonmember" in the Membership Status section,
a $25 per course nonmember fee will be automatically added for each course you may have listed above.

Supplimental members who are on another person's primary membership
must fill out this form separately and include the name of the primary member.

  Current member $
  New member ($35/year, Aug. 1-July 31) $
  Renewing Member ($35/year, Aug. 1-July 31) $
  HSU Alumni Discounted Membership ($25/year, Aug. 1-July 31) $
  Renewing HSU Alumni Discounted Membership ($25/year, Aug. 1-July 31) $
  New Supplemental member ($25/year, Aug. 1-July 31) $
  Renewing Supplemental member ($25/year, Aug. 1-July 31) $
  Nonmember (Adds $25 fee to each course) $
 
Donation: Enter any amount you would like to donate to OLLI
$
 
TOTAL FEES

$

You must enter the image characters below before you can submit this form.

If you cannot read the characters shown, click on the Refresh icon  refresh symbol below until you see an image that you can read.

Alternately, you can click the Speaker icon symbol to hear an audio of the characters. Type what you hear in the box.

If you are still having difficulties, please call 707-826-3731 to register over the phone. (Monday-Friday, 8 a.m.-5 p.m.)



Please review the above information for accuracy before submitting this registration form.

      



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For additional information call (707-826-3731), fax (707-826-5885), or e-mail eLearning & Extended Education.