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OLLI at Humboldt - Follow your passion with Lifelong Learning - Osher Lifelong Learning Institute

Osher Lifelong Learning Institute (OLLI)
Registration Form

Use this form to register and pay for OLLI membership and courses.

If you do not wish to register or pay online, or if you are having trouble with this form,
please download a PDF registration form. (Adobe Reader required)
Print and fill out the PDF form and mail it to OLLI at Humboldt
College of Extended Education & Global Engagement, Cal Poly Humboldt
1 Harpst St., Arcata, CA 95521

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Participant Information

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Select your gender:

Have you ever been enrolled at Cal Poly Humboldt?*

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

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):*

Date of Birth

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

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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 list on this form.

NOTE: You must be an OLLI member (Current, New, or Renewing) to register for Back to Camp.

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Course Selection

Enter the course information for each course you want to take. Click "Add another course" to register for more than two courses.

NOTE: The OLLI Back to Camp program is not open to nonmembers. Please select a Current, New, or Renewing membership option above.

Course 1

Course 2
Add another course

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