LIFETIME MEMBERSHIP APPLICATION

CRYONICS INSTITUTE
24355 Sorrentino Court, Clinton Township MI 48035
Phone 1-586-791-5961, FAX 1-586-792-7062, E-Mail <cryonics@cryonics.org>

MEMBERSHIP APPLICATION

LIFETIME 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_________________________________________

The membership fee for Lifetime Membership is a one-time payment of $1,250 for an individual or $1,875 for a couple (two in the same household). There is no extra membership fee for minor children, including children born or adopted after the parent has become a Member. Additional close family members (spouse, siblings, parents, children) may join with a membership fee of $625 each. Lifetime Membership is permanent, without payment of dues.  Membership confers the right to execute a contract, the right to at least annual financial statements, the right to stand for office according to the By-Laws, and the right to notices and reports of meetings.

Membership fees are not refundable, in whole or in part. They represent one of CI’s sources of capital, spent for such things as real estate, equipment, and research. Membership fees are not transferable. For this option (Lifetime Membership), minimum human contract funding  (whole body) is $28,000, a one-time fee payable approximately at time of death or earlier, by life insurance or other means specified in the contract and tailored to the individual.

Please mail in your membership application with check or money order enclosed to:
Cryonics Institute, 24355 Sorrentino Court, Clinton Township MI 48035

You may also pay by credit or debit card or by PayPal online. To send payment via PayPal, please select “SEND” on the PayPal site’s top menu, and use the address CIHQ@aol.com.

Membership in the Cryonics Institute does not include membership in the Immortalist Society or a subscription to Long Life: Longevity through Technology magazine.  Information on joining the Immortalist Society is available at www.immortalistsociety.org.