Healthy longevity for all through scientific research

Supporters Questionnaire

 
Full Name.
E-mail
Phone Number
Skype handle
Your website
Your Facebook page
Your Twitter page
Your LinkedIn page
City
 
Country

Education, titles, past working positions, scientific articles
Your company and position
Your professional skills
Your skills outside professional field
Knowledge, skills and abilities you would like to acquire
Which languages do you speak fluently?
Your hobbies?
How did you find out about the International Longevity Alliance?
Are you currently helping the ILA or have you already done so? Please specify projects, activities, associations, dates
(For example: I am organising a longevity dinner on October 1st)
What do you like about the idea of healthy longevity?
Choose the form of collaboration that fits you best (multiple answers)  




How much time you could share



Would you like to share some additional information/ question/ proposal?
Do you accept to be mentionned (name and country) in lists of ILA members?
If yes, your name and country can be listed automately, or you may write your version of self-presentation here
Do you agree with the ILA's goals (please read Manifesto)?  Manifesto
*
The ILA will use your personal information only for the activities listed in the Manifesto. Do you accept?  Manifesto
*
 
After you click "Submit" your form will be sent to ILA administration for consideration. After that we will contact you to discuss possible ways of cooperation. Thank you very much for your interest in the International Longevity Alliance!