Institute for Learning in Retirement

Membership Application

First (Given)

Last Name

Other Last Names Used

Email Address

Sex

Birthdate

Home Phone (Landline)

Mobile Phone

Addresses

Billing Address

Country

Street

City

Region

Postal Code

Home Address if different from above

Country

Street

City

Region

Postal Code

Citizenship Information

Primary Citizenship

Additional Information

How did you hear about us?

Previous Occupation/Profession

Special areas of interest

Other Affiliations/Activities

Course Selection

Registration for the Spring 2026 term is $50 per course. Although you can only register to audit one course per term, you can request up to three courses. Please list these in descending order of preference, from most preferred to least preferred.

Please refer to the Spring 2026 course listings for information on available sections.

How many course requests would you like to complete?

Course

First Choice:

Course CRN

Course Name

Second Choice:

Second CRN

Course Name

Third Choice:

Third CRN

Course Name

Cost

Institute for Learning in Retirement

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