Osher - Membership Form

Summer 2009
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Membership Form

PLEASE TYPE OR PRINT CLEARLY

Name:_____________________________________________________

Address:__________________________________Zip Code:__________

Phone:___________________________Email:_____________________

Emergency contact:______________________Phone:_______________

ENROLLMENT INSTRUCTIONS

1. I wish to be enrolled as a Session Member
$ 60 per term

2. Select a total of three courses in which you wish to enroll for this term (print out Course Enrollment Form and select courses).
3. Enclose Course Enrollment Form and Member Form with your Membership Check and mail to:

Osher Lifelong Learning Institute
PMB #460
2440 Campus Road
Honolulu, HI 96822

Make check payable to:
UH Foundation, Account #123-079-04

Or visit our offices on the UH Manoa campus:
Krauss Hall 113