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O SHER L IFELONG L EARNING I NSTITUTE www.uscb.edu (under QuickLinks select Osher) Serving the Citizens of the Lowcountry Phone: N.Campus 521-4113; S.Campus 208-8247; Pineland 208-8239 E-mail: uscbolli@gwm.sc.edu

MEMBERSHIP APPLICATION

Date: ____________ Region:

Beaufort

Bluffton

Hilton Head

Penn Center

Receipt No. _____________

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 Class Assistant

Curriculum Planning Data Entry

Optional Information (for statistical reporting only) Age Range: 40 - 50 51 - 60 61 - 70

71 - 80 81 - 90 90 +

Hospitality Marketing & Membership

Newsletter

Ethnic Background: Male Female

African American American Indian Asian

Caucasian Hispanic 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 cafĂŠ, & 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

Card Number _____________________________________________________________________

MasterCard

Discover

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


http://www.uscb.edu/uploads/OLLI_New_Member_App_7_07