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Questionnaire
Questionnaire
What is your LongeCity username? *
Your answer
What is your name? *
Your answer
What town do you live in? *
Your answer
What state/province are you from? (Please use 2 letter code, ex: CA for California) Include Country if outside the US. *
Your answer
What is your cell phone number? (just numbers, no dashes or parenthesis, don't forget area code) *
Your answer
What is your email address? *
Your answer
Do you have a membership to LongeCity? *
Can we add you on Facebook or other social media by looking you up with your email? *
How old are you? *
Your answer
Are you interested in extending the human lifespan and defeating aging? *
Are you interested in nootropics? *
Are you interested in Transhumanism? *
Are you interested in Cryonics? *
Have you been involved with other local membership organizations such as Rotary, Junior Chamber, Fraternal Orders, etc? *
Please list any local organizations you are currently participating with.
Your answer
Please list any organizations you've participated with in the past.
Your answer
When are you usually available? Assume 1 week advance notice. *
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