Enroll today! (951) 827-4105  |  (760) 834-0997 OSHER LIFELONG LEARNING INSTITUTE  |  UCR EXTENSION  |  FALL 2017 20 Membership and Enrollment Membership Use separate forms for each person.  Membership Renewal  New Membership UCR Retiree?  Y   N Referral?  Y   N Part 1: Print clearly. First Name Middle Initlal Last Name Address City Phone State Zip Code Email Birth Year Part 2: Required to enroll in all Osher LIFE Lecture Series and Osher courses for September 2018 – June 2019. Annual Osher Membership Fee (September 2018 – June 2019) Membership fee is not an enrollment fee and is non-refundable $45.00 Enroll Osher LIFE Lecture Series and Osher Courses Part 3: Current membership required to enroll in Osher LIFE Lecture Series (see Part 2). Annual Osher Life Lecture Series Fee (September 2018 – June 2019) $65.00 Part 4: Current membership required to enroll in Osher courses (see Part 2). Osher Course Enrollment Fees Subtotal from p. 19 Part 5: Annual or quarterly parking permits only. Daily permits available at parking lot dispensers for $5. Annual Osher Parking Fee ValidTuesdaysonlyforOsherLIFELectureSeries. $50.00 Quarterly Parking Permit Valid Mon-Fri only at UC Riverside Extension $30.00 TOTAL FEES DUE Pay Part 7: Choose one.  Visa/Mastercard Number (print clearly) Expiration Date Authorizing Signature  Cash  Personal Check Mail this form with payment to: Osher Lifelong Learning Institute UCR Extension 1200 University Avenue Riverside, CA 92507-4596 How did you hear about us?  Friend/Neighbor  UCR Extension Website  Osher Catalog  UCR Extension Catalog  Newspaper/Calendar Listing  Osher Mailing List  Other Part 6: Refer a Friend. Earn a free Osher class (valued at $25-35). Proof of Friend’s registration required to receive Award Certificate for free Osher class. Name of Friend Check Amount (payable to Regents-UC)