Osher Lifelong Learning Institute (OLLI)
Registration Form

Use this form to join OLLI, renew your membership, give an OLLI membership as a gift, and/or register for courses.

* = Required field

Your Information

Complete this section with YOUR personal information, even if you are giving an OLLI membership as a gift.

* = Required field

First Name*

MI

Last Name*

E-mail*

Mailing Address*

Mailing Address Line 2

City*

State/Province/Region

Country*

ZIP/Postal Code*

Daytime Telephone* (include area code)

Mobile Telephone (include area code)

Emergency Contact Name*

Emergency Contact Relationship*

Emergency Contact Telephone*

Select your gender identity:*

Male

Female

Other

Decline to state

Have you ever been enrolled at Cal Poly Humboldt?*

YES

NO

List all previous names you have used. (Examples: Birth Name, Maiden, Previous Marriage, Legal Name Change)

Have you completed a Bachelor's Degree or higher?*

YES

NO

Additional information:Optional information:

Secure Information

Please supply the following information.
This information is submitted via SECURE SERVER, and is requested pursuant to Section 41201, Title 5, Calif. Code of Regulation and Section 6109 of the Internal Revenue Code.

Humboldt ID or Social Security Number (000-00-0000):*

First three numbers

Second two numbers

Last four numbers

Date of Birth

Your date of birth is required so that Cal Poly Humboldt may identify records that are unique to you.

Month:*

Day: *

Year (4 DIGIT):*

Your Membership Status

Select one membership option. *

Nonmembers: By checking "Nonmember" in this section, a $25 per course nonmember fee will be automatically added for each course you select on this form.

Current Member of OLLI at Humboldt

New Member ($35/year, July 1-June 30) $

Renewing Member ($35/year, July 1-June 30) $

Cal Poly Humboldt Staff/Faculty Member ($25/year, July 1-June 30) * $

Not Yet 50 Member ($35/year, July 1-June 30) $

Nonmember (Adds $25 fee to each course) $

BUY GIFT MEMBERSHIP for a family member or friend ($35/year, July 1-June 30) $

DONATE TO OLLI: Enter any amount you would like to donate. Thank you! $

* NOTE: OLLI Instructors are not considered Cal Poly Humboldt staff or faculty unless currently employed by or retired from the university.

Gift Membership Recipient Information

Thank you for purchasing an OLLI gift membership! Please enter the recipient's first and last names, their email address, and phone number (at least one of these). If you can also answer the other questions, that will make it easier for the OLLI staff to set up your recipient's Cal Poly Humboldt account.

Gift recipient first name
Please enter the recipient's first name.

Gift recipient last name
Please enter the recipient's last name.

Gift recipient email Provide email or phone (at least one is required).
Enter a valid email or fill in the phone field.

Gift recipient phone number Provide phone or email (at least one is required).
Enter a valid phone number or fill in the email field.

To the best of your knowledge, has this person ever been a student/OLLI student/staff/faculty of Cal Poly Humboldt (or Humboldt State University)?
Yes

No

Click to receive the OLLI Newsletter by email (opens another form in a new browser window).

Your Enrollment

Select your membership status above.

Check the box next to each class you want to take.

Classes that are full, canceled, or past their registration deadline will not be available on this form. See the course's webpage for waiting list option, if available.

See the OLLI drop policy for information about dropping classes.

Current OLLI Classes

NEW!Practical Beekeeping (Spring 2026)
Mon., Feb. 9-May 4, 6:30-8:30 p.m., Class #: 23926, $185

$

NEW!Bee Yard Experience (Spring 2026)
Mon., Feb. 15-May 3, 6:30-8:30 p.m., Class #: 23925, $185

$

Special Interest Groups

Live & Local Concert Previews
Mon. Sept. 22 & 29, Dec. 1, March 2, April 6, May 18 & 25, 6-7:30 p.m., Class #: 44055,
FREE to OLLI members only

$

Total class fees:

ONLINE PAYMENT TOTAL:

TOTAL OF ALL FEES:

$

Payment of Fees

* Please select how you want to pay your fees. If you will not pay online upon submitting this form, please select one of the other payment options. If you don't owe a fee, check "no payment is due."

Note that check-paid mailed registrations will not be complete until your check is received by OLLI. For faster registration, select a different payment method.

NOTE: All Cal Poly Humboldt students (including OLLI members/students) will be charged a 2.65% card processing fee when making a credit or debit card payment, whether it's in person, by phone, or through this registration/payment form.

To avoid the card processing fee, you can choose to pay via electronic check in the online payment portal, or pay with a paper check/money order in person or by mail.

I will pay my fees online with a credit card or electronic check.

I will mail a check.

I will pay in person during office hours. (See hours)

I will call (707) 826-5880 with my payment. (See hours)

No payment is due.

Before you submit this form

Please check the box to confirm you are a human before you submit this form.
You may also be required to verify one or more Recaptcha images. Thank you for helping us prevent spam.

Please review the above information for accuracy before submitting this registration form. Once you submit this form, you'll be sent to the payment portal.

Current Member of OLLI at Humboldt
New Member ($35/year, July 1-June 30)	$
Renewing Member ($35/year, July 1-June 30)	$
Cal Poly Humboldt Staff/Faculty Member ($25/year, July 1-June 30) *	$
Not Yet 50 Member ($35/year, July 1-June 30)	$
Nonmember (Adds $25 fee to each course)	$
BUY GIFT MEMBERSHIP for a family member or friend ($35/year, July 1-June 30)	$
DONATE TO OLLI: Enter any amount you would like to donate. Thank you!	$

Select your membership status above. Check the box next to each class you want to take. Classes that are full, canceled, or past their registration deadline will not be available on this form. See the course's webpage for waiting list option, if available. See the OLLI drop policy for information about dropping classes.
Current OLLI Classes
NEW!Practical Beekeeping (Spring 2026) Mon., Feb. 9-May 4, 6:30-8:30 p.m., Class #: 23926, $185	$
NEW!Bee Yard Experience (Spring 2026) Mon., Feb. 15-May 3, 6:30-8:30 p.m., Class #: 23925, $185	$
Special Interest Groups
Live & Local Concert Previews Mon. Sept. 22 & 29, Dec. 1, March 2, April 6, May 18 & 25, 6-7:30 p.m., Class #: 44055, FREE to OLLI members only	$

Osher Lifelong Learning Institute (OLLI) Registration Form

Secure Information

Payment of Fees

Osher Lifelong Learning Institute (OLLI)
Registration Form