OLLI at ASU
Mail-In Registration Form
Summer 2017 Semester
This form is provided for those registering by mail with a check (NO CASH PLEASE).
To register and pay with a credit card, please call Sally: 602.543.6440.
Name and mailing address (please print clearly):
Date
Email
How did you learn about us this semester?
Osher Email
Word of mouth
Radio: KBACH or KJZZ
Osher Website
My community
Other:
Osher Class Schedule
Facebook
(Your e-mail makes it easier for us to send you lifelong learning and ASU information.)
Home phone (
)
Birth month and year
Other/Cell phone (
Female
Male
(For our demographic records only)
Where did you get the Class Schedule? Osher ASU website _______
Requested it_______
Picked it up at_______
)
I am a NEW OLLI at ASU member
I am an ASU Alum
Mail _______
Friend or family _______
Other _______
1. Select your classes from our Class Schedule and write them on page 2 of this form.
2. Pay for your classes:
Enter total of Class Fees (from page 2)
$
OLLI at ASU Semester Membership Fee
$ 10.00
Are you a current ASU Alumni member?
ASU Alumni member discount
$If yes, did you enroll in a $10 lecture? If yes, provide your ASU Alumni ID # ________________
and deduct $10 from your class total (does not apply to membership fee). If you would like to know about
this benefit, please call Sally at 602.543.6440.
TOTAL DUE $
Your signature:
Make your check payable to ASU. (NO CASH PLEASE)
Send this form & your check to:
ASU / Osher Lifelong Learning Institute
MC 3251
PO Box 37100
Phoenix, AZ 85069-7100
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Please list the classes you would like to take:
Mailing your Registration Form does NOT guarantee a seat if a class is full when your form arrives. Your
confirmation is instant if you register online. We encourage you to pay your membership and class fees with
a credit card on our website at lifelonglearning.asu.edu or call the OLLI office at 602.543.6440.
Campus location
Title of Class
Instructor
Date(s)
Class Fee
Refund Policy: Membership fees are non-refundable. Class fees are non-refundable, except in the event a class is
cancelled. In this case, the applicable fee will be refunded at the close of the semester. Fees, scheduled times and
offerings are subject to change.
Questions? Call Sally at 602.543.6440, or email [email protected].
Please do not send credit card information or cash in the mail.
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