4 OLLI at UAH Membership and Course Registration Easy Ways to Register

OLLI at UAH Membership and Course Registration
Please fill out the appropriate sections below.
A. PERSONAL INFORMATION
4
Easy Ways to Register
Full Name __________________________________________________________
Street Address ______________________________________________________
City/State/Zip _______________________________________________________
Phone: Home ____________________ Cell _______________________________
ONLINE at
PCS.uah.edu/OLLI
Registration
PHONE
256-824-6010
IN PERSON at PCS
Registration Office.
See address below.
MAIL registration
form to address
below.
Email ______________________________________________________________
□
I do not have an email address
B. OLLI ANNUAL MEMBERSHIP (August – July)
Select one:
□
□
□
I am already an active OLLI Member (Skip to Section C)
New Member
□
Renewal_______________________________________
Gift Membership From ___________________________________________
Message ___________________________________________
□
□
2014/2015 – 1-year = $16 ($15+ $1 handling)
2014/2016 – 2-year = $32 ($30+ $2 handling)
*Enclosed Membership Fee: $________________
UAH PCS Registration Office
Wilson Hall, Room 103, UAH Campus
Huntsville, AL 35899
Office Hours: Mon – Fri, 8:15 am – 5:00 pm
Signing Up for Term Courses:
• An active OLLI annual membership is
required to register for term courses.
Term Year: Aug 1 – July 31.
Badge Name _______________________________________________________
• $85 per term allows you to register for up
to six OLLI courses.
C. TERM COURSE REGISTRATION
• $10 for each additional course. Plus any
applicable lab or supply fees.
□
Please Sign me up for Term Courses
Session ID __________________________ Session ID ___________________________
Session ID _____________________________ Session ID ___________________________
Session ID _____________________________ Session ID ___________________________
$_______________________
Register Early – Classes Fill Up Quickly
One form per person. Indicate your choices by session
ID number. You will receive your OLLI term parking
decal and confirmation by mail showing the courses
in which you have been enrolled. If you registered
online, you will also receive an email confirmation.
$85 Course Term Fee: Applicable Lab/Supply Fees: $_______________________
Seating is Limited
Plus $10 Per Course Over 6: $ _______________________
TOTAL PAYMENT: $________________________
You will be notified at least four working days in
advance if a course is cancelled due to low enrollment. Registration fees are non-refundable unless
your selected course(s) are not available.
D. PAYMENT INFORMATION
□ Check Enclosed, payable to UAH PCS
□ VISA □MasterCard □Discover □AMEX
Card # _________________________________ Exp. Date __________________
Cardholder’s Name __________________________________________________
Cardholder’s Signature _______________________________________________
• OLLI at UAH is not responsible for any damage or personal injury sustained
when a member is participating in any OLLI-sponsored activitis on or off the
UAH Campus
• Membership implies permission to use your photo for OLLI publicity. If you do
not want your photo used, please notify the instructor/photographer in advance.
• A parking decal is required for all cars on campus.
Questions: Maxine or Jessica
256-824-6183
OLLI at UAH Scholarship –
Contribute Today!
The OLLI at UAH Scholarship is a perfect way
to contribute to the success of young people.
Through the generous donations from OLLI
members, annual scholarships are awarded
to deserving undergraduate students to help
them achieve their educational goals.
www.PCS.uah.edu/DonateOLLI
Rev1014
`