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Healthspan Collective Partnership Request 2026
First email should be the logistical contact person
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First and Last Name of main contact
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Your answer
Phone number of main contact
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Your answer
Email of main contact
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Your answer
Company Legal Name
Your answer
Brand Name (if different)
Your answer
Type of Partner - Select all that apply OR write "not sure" if you want to request more information
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Founding Patron - Total Ecosystem Integrations for 1 year
Healthspan Summit - October 1-3, 2026 - Signature Event 1000+ Attendees
Longevity Leadership Conference - April 30, 2026 (300 people B2B)
Healthspan Salon Partner (under 100 people)
Digital Community
Academy, Education or Webinars
Not Sure
Other:
Full mailing address for agreement and invoice
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Your answer
Company Website URL for promotions
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Your answer
Preferred Social media handle - IG, LinkedIn, or..? Please provide link.
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Your answer
Other social media profile links - optional
Your answer
Please provide a link to a high resolution png (transparent) logo
TO THIS FOLDER
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Done
We will send by email to
connect@healthspanevents.com
Are you interested in providing products for Gift Bags or Raffles? We will follow up on this if you say YES to any of the below.
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YES - For all members
YES - For VIPs ONLY
YES - Willing to provide raffle items (better for higher priced products)
No - not interested in providing gift bag or raffle items
Other:
Required
Anything else we should know?
Your answer
Our team is looking forward to collaborating with you and will be in contact soon!
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