ElderCollege Membership Application Form
Joining ElderCollege is a commitment to yourself and to a world of new discoveries. Join today!
PLEASE NOTE: ElderCollege does not share its membership lists and does not release any member information without written consent.

Print out and complete this application form and return it with payment to:
ElderCollege Membership
Extended Studies/Mail Stop 048
University of Nevada, Reno
Reno, NV 89557
Fax: (775) 784-4801
For more information, call Shera Alberti-Annunzio at (775) 784-4046.

Name _____________________________________________________________
Mailing address _____________________________________________________
City _____________________________  State ________ Zip ________________
Day phone (______) ______________ Business phone (______) ______________
E-mail (optional) ____________________________________________________
(for receiving ElderCollege updates and other announcements)

How did you hear about ElderCollege? __________________________________________________________________
__________________________________________________________________
__________________________________________________________________

Annual Membership: $45 per person
• Membership year is September 1 through August 31.
• Membership fees cover activities and classes approved by ElderCollege.
• April-August membership $25 per person (expires August 31)
• Annual parking permit: $15 (Lot adjacent to ElderCollege)

[ ] Enclosed is a check for $__________ payable to the Board of Regents.
[ ] Or please charge my: [ ] VISA [ ] MasterCard [ ] Discover [ ] American Express
Cardholder’s Name__________________________________________________
Card Number___________________________ Expires_____ Amt.____________
X________________________________________________________________
(Signature as it appears on card)

The University of Nevada, Reno is an Equal Opportunity/Affirmative Action, ADA institution.
A portion of program fees may be used to pay hosting expenses. Produced by Extended Studies Marketing Dept., 2003.