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 _________________
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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