Member or Guest Information
Please provide valid email address and full mailing address. Email and mailing address will remain private and will not be shared outside the University of Richmond. Fields with asterisks (*) are required.

UR ID#	*Required for Osher members
Date of Birth*	mm/dd/yyyy
First Name*
Last Name*
Email Address*
Address Line 1*
Address Line 2
City*
State*
Zip*
Daytime Phone*
Other Phone
Registration Status*	Have you ever registered for credit or non-credit programs at University of Richmond? Yes No If yes, indicate your name when you registered (if different from above):
Alumni Status*	Are you a University of Richmond alumna/us? Yes No If yes, indicate year and degree below: Year: (yyyy) | Degree: (e.g. Bachelor of Liberal Arts)

Course Information
Review the course details found on the Schedule of Classes for title and start date. Use this form to register for up to ten courses. Be sure to include start date for each course selected. At least one course must be listed.

If you would like to register for more than ten courses, you may return to the "Register for a Class" page to complete this form again. Your Gold or Gold Plus One membership entitles you to register for as many Osher Institute classes as you'd like.

CRN (xxxxx)	Course Title Enter one course title per line.	Start Date (mm/dd/yyyy)