ILA Membership Application (individual or federated members, or branches)
Sign in to Google to save your progress. Learn more
Please choose the type of membership you apply for
Clear selection
Your full name
Your position in your organization
Your organization name
Your organization full address (including postal code)
Your phone number
Your email address
Website and/or social media page
Please briefly describe your and/or your organization's contribution to the longevity field, past, present and planned. Please add any relevant details about yourself and/or your organization.
How do you envision your cooperation with and within the ILA for the advancement of the longevity field? What would be the goals and ways of cooperation?
By sending this form I confirm that I have read the ILA manifesto, and I express my readiness to support the development of therapies and technologies for healthy longevity by means listed in the Manifesto.
Clear selection
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy