Osher at CMU - Carnegie Mellon Affiliate Application

CMU Affiliate, Thank you for your interest in becoming a member at Osher at CMU!

The Osher Lifelong Learning Institute at CMU is pleased to announce that the organization is now accepting immediate membership from the Carnegie Mellon community. Affiliates are restricted to:
- Active Employees (current and up to 1 year after retirement) are defined as current faculty or staff who are "medical benefits eligible" and their spouse or legal domestic partner.
- Former Employees are defined as former faculty or staff and their spouse or legal domestic partner who would be "medical benefits eligible" or former faculty or staff that has at least 10 years of cumulative service with CMU.
- CMU Alumni must have graduated from Carnegie Mellon University with an undergraduate or graduate degree. Parents /spouse of CMU Alum are also invited to membership.
Please allow up to one business week to process your application. This allows the Osher office the necessary time to verify affiliation status with Carnegie Mellon University.

If you are not a CMU Affiliate, please complete this form instead:

Going forward, we plan to offer our courses on Zoom and in person; so if you live out of the immediate Pittsburgh area, the opportunity to take courses will still be available. Thank you for your interest in joining the Osher at CMU community.
Username
Email*
example@example.com
First Name*
Last Name*
Have you been an Osher Member before?*

YesNo
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Cell Phone Number*
Please enter a valid phone number.Format: 000-000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: 000-000-0000.

Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: 000-000-0000.

What is your affiliation to Carnegie Mellon?*

CMU AlumParent/Spouse of CMU AlumCurrent CMU Faculty/Staff Member or Spouse OfFormer CMU Faculty/Staff Member or Spouse Of
CMU Alum

CMU Alumni must have graduated from Carnegie Mellon University with an undergraduate or graduate degree.
Relation to the Alum*

ParentSpouse
Name Listed on the Degree*
Degree Earned*

BachelorsMastersPh.D
Graduation Year*
Major*
Current/Former CMU Faculty/Staff Member or Spouse Of

Active Employees (current and up to 1 year after retirement) are defined as current faculty or staff who are “medical benefits eligible” and their spouse or legal domestic partner.

Former Employees are defined as former faculty or staff and their spouse or legal domestic partner who would be “medical benefits eligible” or former faculty or staff that has at least 10 years of cumulative service with CMU.
Name of Faculty Member/Staff Member*
Department(s)*
Year Hired*

Osher Lifelong Learning Institute at Carnegie Mellon University

GENERAL RELEASE AND ACKNOWLEDGMENT

I, [name will appear here] understand and acknowledge that in signing this document, I am releasing Osher Lifelong Learning Institute at Carnegie Mellon University (“Osher at CMU”) and Carnegie Mellon University (“CMU”) from any liabilities arising from or connected with my presence on CMU premises and/or my participation in Osher at CMU activities, including, without limitation, working/volunteering, classes, off-site activities, and exercise courses (collectively, “Osher at CMU Activities”).

Participation in Classes and Off-Site Activities: I want to participate in classes and/or off-site activities such as trips, excursions and tours arranged through Osher at CMU, but occurring at locations other than Osher at CMU’s facilities on the CMU campus.
- I understand and acknowledge that Osher at CMU may arrange transportation to such Osher at CMU Activities, but depends on the transportation provider to select and maintain its equipment and to select and check the accreditation of its drivers.
- I also realize that if overnight or other accommodations are required, Osher at CMU depends on the food and lodging suppliers used during Osher at CMU Activities to maintain the cleanliness, healthfulness and condition of their food, supplies, and facilities.
- Likewise, I understand that Osher at CMU depends on the owners and managers of destinations that are visited as part of Osher at CMU Activities to maintain the condition of their facilities or locations.
- Osher at CMU does not provide any independent verification of the responsibilities of transportation suppliers, food and lodging providers or destination owners or managers.
Participation in Exercise Courses: I want to participate in exercise courses through Osher at CMU.
- I acknowledge that Osher at CMU recommends that it is especially important, as our bodies age, and we take medications that can affect our overall fitness to exercise, that before I participate in exercise courses, I consult with a physician who can help me to assess my fitness for participation as well as any risks inherent in my participation.
- I acknowledge that such an evaluation is beyond the capabilities of Osher at CMU and is solely my responsibility. I realize that Osher at CMU will not have trained medical personnel on the premises during the exercise courses.
Assumption of Risk and Release of Liability: I understand that there are hazards and risks as well as benefits associated with my participation in Osher at CMU Activities. In consideration of the benefits that I may receive from participation in Osher at CMU Activities, I, on behalf of myself and those acting on my behalf, irrevocably and unconditionally release, waive, and promise not to sue Osher at CMU and Carnegie Mellon University and each of their respective employees, officers, directors, trustees, agents, and representatives, and any others acting on either of their behalves, from, for and against any and all liabilities, losses, injuries, damages, claims, demands, expenses, actions and/or causes of action arising from or connected with my participation in the Osher at CMU Activities or the securing or failure to secure emergency medical treatment for me as a result of my participation in Osher at CMU Activities or my presence on CMU premises.

Osher at CMU as Separate Entity: I understand and acknowledge that, although Osher at CMU is located on CMU premises, Osher at CMU is a 501(c)(3) association organized under the laws of the Commonwealth of Pennsylvania separate and apart from CMU and is not managed, supervised, controlled, or affiliated with CMU. I further understand and agree that CMU is not responsible for the conduct of Osher at CMU or the Osher at CMU Activities.

Miscellaneous: The laws of the Commonwealth of Pennsylvania shall apply to this release. I sign this release with the intent to be legally bound by it. I am an adult 18 years or older and am competent to sign this release. I am signing it voluntarily. I have read it and understand its contents.
I understand that Osher at CMU will retain this General Release and Acknowledgement for the duration of my membership. I understand that my membership application will be processed upon receipt of this General Release and Acknowledgement by Osher at CMU.*

I agree.
Date*

MonthDayYear
Date
Should be Empty:

CMU Affiliate, Thank you for your interest in becoming a member at Osher at CMU!

CMU Alum

Current/Former CMU Faculty/Staff Member or Spouse Of