Rudi Hoffman Certified Financial Planner

Rudi Hoffman

Certified Financial Planner™

Cryonics Quote Request Form

"The cost of cryonic preservation may be affordable by funding the cost through a life insurance policy. For a monthly premium payment, you can create an instant source for paying for your suspension."

"This information will be used only for getting you the most appropriate and cost effective quote options. There is no cost or obligation to find out what your life insurance costs may be, and you may be surprised how affordable and attainable this technology can be. Forms without complete information, including phone number, will probably be fed to the dogs. Also, please use the open form at the bottom to tell me anything about yourself that you think I might like or need to know."

Cryonics Quote Request Form To receive your free quote, please fill out the form below. All form information submitted will remain completely confidential.

Contact Information First Name Middle Initial Last Name E-mail Phone
Postal Address Street Address City State Zip Code
Nicotine Usage Nicotine Usage within 12 months
Nicotine Usage within 3 years
Birth Date Month Day Year
Sex Marital Status
Height Weight
U.S. Citizen Status Are you a U.S. citizen If not a U.S. citizen: What Country of Citizenship Visa Type
Other Preferred Cryonics Vendor
Form of Suspension
Hazardous Sports
Pre-existing Health Issues
Did either of your parents die from heart problems or cancer before age 60?
In the past 3 years, have you traveled outside the US?
In the last 5 years, have you had any moving violations?
How did you hear about our web site?
On a scale of one to ten, with ten being the highest interest, how would you quantify your intention to sign up for cryonics in the very near future?
Have you viewed the 3 two minute videos on the cryonics signup process here
If other, please tell us where
Please provide details regarding "Yes" answers to health or moving violations above. Additionally, please write here with any other information you think I should know.