OSHER LIFELONG LEARNING INSTITUTE
AT THE
Application for Membership- 2007-2008
All new and returning members:
please complete this application and return with or without a completed
event registration form to:
Osher Lifelong Learning Institute at the
(734) 998-9351
Name: (Last, First)
Title of Preference
o Mr.
o Mrs.
o Ms.
o Miss
o Dr.
o Prof.
Email Address:
Full Street Address:
City_________________________ State: ________ 9 Digit Zip______________
Emergency Contact’s Name, Relationship and Daytime Phone Number: _______________________________________________________________________
Sex
o Male
o Female
Race (for statistical purposes only; response optional)
o African-American
o Asian or Pacific Islander
o Caucasian
o Hispanic
Birth Year______
Retirement
o Full
o Partial
o Not yet retired
Educational Background (a degree
is not a pre-requisite for membership in OLL/UM; for statistical
purposes only; response optional))
o High School
o Baccalaureate
o Masters
o Doctorate
o Professional Certificate
Special Fields of Study (either formal training or individual intellectual pursuits)
Life / Career Experiences (e.g. homemaker, businessman, administrator, teacher)
How did you learn about Osher Lifelong Learning Institute at the University of Michigan?
o OLL Mailing such as newsletter, lecture flyer or class catalog
o Turner Senior Resource Center Mailing
o Local newspaper ad (such as Ann Arbor News or Observer)
o Friend’s Recommendation
o Visit to
o Visit to
Fields of Interest (check all that apply)
o Art
o Music
o Dance
o Drama
o Literature
o Writing
o Languages
o Geography
o History
o Philosophy
o Religion
o Economics
o Finance
o Social Sciences
o Natural Sciences
o Astronomy
o Women’s Studies
o Current Events
o Physical Health
o Mental Health
o Travel
o Hobbies
o Retirement
o Biography