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