OLLI at SOU
Spring 2014 Membership Application
www.sou.edu/olli
Please print clearly (or save form, then open in Acrobat Reader and type into the form before printing).
First Name _______________________ Middle Initial _____ Last Name ________________________________
Name as you wish it to appear on membership badge ________________
_________________________
Date of Birth ________________ Day Phone _______________________ Mobile ________________________
Address _______________________________________________ City __________ _ State ___ Zip________
Email______________________________________________
Returning OLLI member
New member How did you hear about OLLI?___________________________
PLEASE LET ME HELP
ENHANCE YOUR LIFE – JOIN OLLI at SOU
Annual Membership Dues of $75 are for the Spring 2014 term
and are non-refundable.
Check below and fill in amount(s):
Membership dues @ $75 per person
$__________
Instructor credit (include credit slip with this form) less - ($__________)
SCH (for staff notation only) $__________
My tax deductible gift to The OLLI Annual Fund $__________
TOTAL OF DUES AND DONATION
$__________
Payment of your OLLI registration dues and donation can be combined.
Pay by check:
Make check to “SOU Foundation” (add “for OLLI” on memo line)
The OLLI Annual Fund:
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Supports and sustains our programs
Keeps dues low and affordable for all
Helps cover unanticipated costs
Diversifies our revenue base
All gift amounts are confidential.
Donations in excess of member dues are tax
deductible to extent of law.
Please check all that apply:
Joint gift with spouse/partner
Contact me regarding Matching Gift
Contact me regarding a Planned Gift
Please list my gift as Anonymous
Pay by credit card:
Visa
MasterCard
Credit card # ___________________________________________
THANK YOU! Your gift matters.
Expire Date: ______ Amount charged on card $ ______________
OLLI is an affiliate of the SOU Foundation,
Federal Tax I.D. # 23-7030910
X ___________________________________________________
Signature (sign as name appears on your credit card)
Print Name _____________________________________________
Pay by phone: I will call the OLLI office with my credit card
number.
OLLI’s MISSION STATEMENT
The Osher Lifelong Learning Institute at SOU is
an adult, member-driven educational community
established to foster intellectual curiosity and
continuous learning.
Learn. Just for the Fun of It!
Complete both pages of this application and mail to or drop off at:
OLLI at SOU
Division of Continuing Education
Southern Oregon University
1250 Siskiyou Blvd., Ashland, OR 97520
Office phone: (541) 552-6048
SOU NONDISCRIMINATION POLICY: It is the policy of Southern Oregon University that discrimination on the basis of race,
national origin, religion, sex, age, handicap or marital status shall not exist in any form in the operation of the University. This
nondiscrimination policy covers admission and access to, and treatment and employment in University Programs and activities.
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OLLI Member Profile
Please help us get to know you better. Your responses are for internal use.
____________________________________ _____________________________________
First Name
Last Name
1. SKILLS. In which of the following general areas have you developed skills through your life or professional
experience? Check all that apply.
Audiovisual, technical support
Legal
Budgeting, accounting, financial
Marketing, advertising, PR
Building trades, design, construction
Personnel management, conflict resolution
Clerical, office, phones
Photography
Computer usage
Social event planning, support
Educational program, curriculum development
Strategic planning
Fundraising, grant writing
Teaching, instructing, training
Gardening, landscaping
Writing, editing
Graphic design, web development
Other: ___________________________________
2. INTERESTS. In which of the following areas might you have an interest in contributing now or in the
future? Check all that apply.
Audiovisual, technical support
Legal
Budgeting, accounting, financial
Marketing, advertising, PR
Building trades, design, construction
Personnel management, conflict resolution
Clerical, office, phones
Photography
Computer usage
Social event planning, support
Educational program, curriculum development
Strategic planning
Fundraising, grant writing
Teaching, instructing, training
Gardening, landscaping
Writing, editing
Graphic design, web development
Other: ___________________________________
3. PREFERENCES. Help us provide you with the OLLI experience you want. Check the statement(s) below
that indicate what you’re seeing from your membership.
I would like to get to know more members through social events.
I would like to get to know more members through working on OLLI projects or committees.
I would like to work on an OLLI project but prefer to work on a solo basis.
I would like to teach or facilitate an OLLI course.
I would like to be a lecturer or panelist for a one-time OLLI lecture.
I would like to participate in an OLLI leadership role (committee chair or Council member).
My sole interest is taking OLLI classes rather than any of the above.
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