ANNUAL (Yearly) 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

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 for future cryopreservation are not in force (all contracts for present cryopreservation remain in force). 

Membership fees are not refundable or transferable, in whole or in part.

For Yearly Membership members, minimum human 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.  Credit will be given for dues paid within the previous year.

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.