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
  -    - 
To identify your HSU record, we require you to enter your date of birth:*                      

Course Information

Enter the course information for each course you want to take.

Class Number
Course Title/Topic

Fees*
Enter numerals only

$
$
$
$
$
 
Total Fees for Classes
$

MEMBERSHIP STATUS

Select one: *

  New member ($35/year, Aug. 1-July 31) $
  Renewing Member ($35/year, Aug. 1-July 31) $
  Current member $
  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

$

Please review the above information for accuracy before submitting this registration form.
If form will not submit, you'll need to review that all the required information is entered above.
Missing information will be marked.

      



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