A Continuing Learning Experience
OLLI New Member Registration
To register for OLLI, please fill out the form below. Returning members will be redirected to the CSUF Student Portal to log on using their username and password. For assistance or questions regarding this process please contact Michelle Sanford at 657-278-4270 or
msanford@fullerton.edu
.
Please select one:
New Member
Returning Member / Renewing Member
Member Information:
(All * fields required.)
*
First Name:
Middle Name:
*
Last Name:
Suffix:
Select Suffix
Sr.
Jr.
III
Ph.D.
M.D.
*
Address:
*
City:
*
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylviana
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip:
*
Personal Email:
*
Phone Number: (xxx-xxx-xxxx)
*
Date of Birth: (mm/dd/yyyy)
You must be at least 45 years old to register.
*
Ethnicity:
--- Select One ---
American Indian
Asian
Black
Chicano
Filipino
Other Hispanic
Pacific Islander
White/Caucasian
Unknown
Decline To State
Name to appear on badge: (if different from First name)
*
Gender:
Male
Female
*
Do you need an OLLI Parking pass?
Yes
No
*
Have you previously had a CSUF student, staff, or faculty account?
Yes
No
The ChroniCLE (OLLI Monthly Newsletter) is delivered via email and copies are available in the office. Additionally, you may request a copy be delivered by US Mail by checking this box.
The Blue Book (course catalog) is delivered each semester via email and copies are available in the office. Additionally, you may request a copy be delivered by US Mail by checking this box.
*
Are you willing to put name/address/phone/email onto an OLLI ride-sharing list?
Yes
No
*
Are you interested in volunteering at OLLI?
Yes
No
*
How did you hear about OLLI that prompted you to join?
Emergency Contact Information:
(All * fields required.)
*
Name:
Address(optional):
City(optional):
Zip(optional):
*
Phone Number: (xxx-xxx-xxxx)
Membership Type:
Membership Type
Select Membership Type
Summer 2023
Membership Fee
Total Fee:
I have reviewed the
Committment to Positive Member Experiences, OLLI's Ethical Environment Policy (Policy 2.6) and the CSUF Commitment to Civility
Clear Form Data
