CRYONICS INSTITUTE
24355 Sorrentino Court, Clinton
Township MI 48035
Phone 1-586-791-5961, Phone/Fax 1-586-792-7062, E-Mail
<cryonics@cryonics.org>
MEMBERSHIP APPLICATION
YEARLY MEMBERSHIP
Name(s)_________________________________________________________________________
Address_________________________________________________________________________
________________________________________________________________________________
Telephone_______________________________Fax______________________________________
E-Mail Address____________________________________________________________________
Date of Birth of Applicant________________________________ Gender of Applicant: M / F (circle)
Date__________________________ Fee(s) enclosed______________________________________
Signature of Applicant_______________________________________________________________
Signature of Parent/Guardian if Applicant is a minor_________________________________________
For Yearly Membership the application must be accompanied by the initial dues payment and a $75 initiation fee. This secures your current membership and the right to execute a contract. Dues under Yearly Membership are $120 per year or $35 quarterly, in advance. If dues are not paid when owing, membership lapses and contracts are not in force. Membership fees are not refundable or transferable, in whole or in part.
For Yearly Membership members, minimum contract funding is $35,000, whole-body, a one-time payment approximately at time of death or earlier, by life insurance or other means specified in the contract.
Yearly Membership members may switch to Lifetime Membership at any time, by paying the $1,250 Lifetime Membership fee.
Membership in CI does not include membership in the Immortalist Society, but for the foreseeable future includes a subscription to The Immortalist. A full membership in the Immortalist Society costs $75. For full membership in the Immortalist Society, please add $75 and check here [ ].
Please send in your membership application with check enclosed. We can accept credit card payments for membership by phone, in writing or through Paypal (www.paypal.com, payable to CIHQ@aol.com).