Osher Lifelong Learning Institute

Annual Membership

including membership in PLATO, a program of OLLI

Online Form to Join or Renew

New or Renewal?	New Member Renewal
First Name
Last Name
Preferred Nickname
Street Address
City
State
ZIP Code
Phone (with area code)
E-mail Address
Work Experience (kinds, current status)
Are you still working?	No Yes, part time. Yes, full time.
Volunteer Work (organizations, responsibilities)
Please indicate your specific areas of interest	Art Current Events History Literature Music Philosophy Science Travel World Religion
Are you interested in attending evening programs?	Yes No
Are you willing to coordinate or lead a discussion group?	Yes No Topic, if yes:
Would you serve on a committee?	Outreach (newsletter, communications, membership) Special Events (day tours, lectures, social events) Curriculum (discussion-group planning) University Relations (administration)
Gender	Male Female
Birth year
Comments

Contact the Division of Continuing Studies

608-262-5823 • slp@dcs.wisc.edu
21 N. Park St, 7th floor, Madison WI 53715

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• If you cannot renew online: print and mail
  membership form (pdf)
• Return to OLLI home