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Date: ____________ MEMBERSHIP APPLICATION Receipt No. _____________ Region: Beaufort Bluffton Hilton Head Penn Center Jasper County (Please check one)
Mr. Mrs. Ms. Dr. Name of Subdivision or Plantation: ________________________________ Name: _____________________________________________________________ Phone: ________________________________ Address: ___________________________________________________________ Cell: __________________________________ City/ State/Zip: ________________________________________________ E-mail: _________________________________________
Please complete the following:
How did you learn about OLLI? � Friend � Media � Newcomer packet � Website � Presentation: Date_______________ Location_____________________________ Other ____________________________________________________
Would you teach or facilitate a course Yes No If yes, list subject area(s): __________________________________________________________________________________________________________
Are you willing to be a volunteer? Yes No If yes, which of the following areas are of interest to you?
Administrative Support Curriculum Planning Hospitality Newsletter Class Assistant Data Entry Marketing & Membership
Optional Information (for statistical reporting only) Age Range: Ethnic Background:
40 - 50 71 - 80 Male African American Caucasian 51 - 60 81 - 90 Female American Indian Hispanic 61 - 70 90 + Asian Other _________________
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Would you consider Osher Lifelong Learning Institute (OLLI) as one of your charities? By South Carolina State law, lifelong learning programs must be self-supporting and receive no state funds.
Your gift will help in building an even better OLLI program.
Gift (tax deductible) $____________________
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Membership Fee*............$35/year
*Membership is open throughout the year and is renewed annually. Membership allows you to register for courses for a small fee (see current
Curriculum Guide), receive all OLLI communications, and to be eligible for all USCB/OLLI privileges such as library, cyber café, & special events.
Accepted payment methods: cash, checks (made payable to USCB/OLLI) or credit card (Visa, MasterCard & Discover) If paying by Credit Card fill out below: Name as appears on card (Please Print) __________________________________________ Visa MasterCard Discover Card Number _____________________________________________________________________ Expiration Date: ____/____
(mo / yy) Signature _________________________________________________________ Amount to charge card $___________________
Mail all payments to: USCB/OLLI, 1 University Blvd., Bluffton, SC 29909 Credit Card payments may be faxed to: 843-208-8291
www.uscb.edu (under QuickLinks select Osher) Revised 07/07
OSHER LIFELONG LEARNING INSTITUTE www.uscb.edu (under QuickLinks select Osher) Serving the Cit izens of the Lowcountry Phone: N.Campus 521-4113; S.Campus 208-8247; Pineland 208-8239 E-mai l : uscbol l [email protected]
