* First name
Nickname (preferred short form of your first name like Bob instead of Robert) used on name tags.
* Last name
* Year of Birth
* Your email address
* Re-enter Your Email address
* Password (6 to 16 letters/numbers/punctuation)
* Re-Enter Password
* Phone (999-999-9999 enter hyphens)
* Is this a cell phone?
* Emergency contact name
* Emergency contact phone (999-999-9999 enter hyphens)
* Emergency contact email address
* How did you hear about OLLI-UA? If you were referred by someone or a specific organization please list their full name so we can acknowledge them.
Professional Background and Areas of Expertise. Short and simple. For example, a ballroom dancer and tax accountant for 18 years.
Please complete this form to create an account. Required fields are indicated by a red *.
Creating an account will allow you to purchase memberships, register for classes and access other OLLI-UA member benefits.