Please Print

OLLI REGISTRATION FORM

Name(s)_________________________________________________________
E-Mail Address:___________________________________________________
Street Address:____________________________________________________
City: _____________________________ Zip:_______________
Phone:___________________________________________________________

    2007-2008 Membership                                    Number_____@$10.00 each
    Required for all attendees                              Payment enclosed:                  $_____
    Effective balance of year to Aug. 31, 2008

    5th 2007-2008 Thursday Morning Lecture Series  Number of attendees:_____
    $30.00 per person                                         Payment enclosed:                  $_____

    6th 2007-2008 Thursday Morning Lecture Series  Number of attendees:_____
    $30.00 per person                                         Payment enclosed:                  $_____

    Distinguished Lecture Series (Second Tuesday)   Number of attendees:_____
    $35.00 per person                                         Payment enclosed:                  $_____

                                                                        Total Payment enclosed:          $_____

Mail or pay in person to:    OLLI at UM
                2401 Plymouth Rd. Suite C
                Ann Arbor,MI 48105

Write Check payable to:    “OLLI”

If you have questions:        Phone: 734-998-9351
                Fax: 734-998-9340
                E-mail: atai@med.umich.edu
                Website: www.umlir.org


OFFICE USE ONLY:            Date Received:________
    Check    Check #__________    Credit from:__________

    Cash    Amount: $________    Processed by: _________   

For statistical purposes only: Check the box(es) that appl(y)ies
White Black or African-American American Indian and Alaska Native
Asian Native Hawaiian and Pacific Islander Other race