Rudi Hoffman Rudi Hoffman, Certified Financial Planner™

Rudi Hoffman

Certified Financial Planner™

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Cryonics Quote Request Form

"The cost of cryonic preservation can be extremely affordable by funding the cost through a life insurance policy. For a reasonable 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.

First Name
Middle Initial
Last Name
Street Address
City
State
Zip Code
E-mail
Phone
Nicotine Usage within 12 months Yes     No
Nicotine Usage within 3 years Yes     No
Sex Male     Female
Marital Status Married     Single
Birth Date:  
Month 
Day 
Year 
 
Height
Weight
Are you a U.S. citizen Yes     No
If not a U.S. citizen: What Country of Citizenship 
Visa Type 
Preferred Cryonics Vendor Alcor
Cryonics Institute
Unsure
Form of Suspension Neurosuspension
Full Body
Unsure
Occupation
Hazardous Sports
Pre-existing Health Issues
Did either of your parents die
from heart problems or cancer before age 60?
Yes     No
In the past 3 years,
have you traveled outside the US?
Yes     No
In the last 5 years,
have you had any moving violations?
Yes     No
How did you hear about our web site?
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.