Coalition to Extend Life

C.E.L. Membership


Please complete this form and with the proper payment instrument mail it to
C.E.L.
1717 K St. N.W. # 600
Washington, DC 20036
202-445-4876

The information sent by this form will be secured. secured

Yes! I want to support a movement to make immortality a reality during my lifetime!

As a member of C.E.L., I understand, I will receive:

  • A quarterly newsletter informing me of relevant news and information on the fight to achieve immortality
  • A stone Dragonfly pendant the ancient symbol of immortality
  • A T-shirt signifying my support of this movement. Please select the appropriate size:
  • A packet of 10 postcards for friends and relatives
Payment:

Check
My check for $30.00 payable to the Coalition to Extend Life for a
one-year membership in C.E.L. has been sent.

Please send checks to:
1717 K St. N.W. # 600
Washington, DC 20036
202-445-4876

Credit card

Please charge my:

Credit card number:

Exp. Date:

Exp. Year:

Contact Information:
*First Name

*Last Name
*Address
*City

*State

*Zip
*Telephone

Fax
*E-mail Address
Donations:
P.S. As you know organizing a national campaign on this issue is difficult. But in the end we will prevail. If you are excited about C.E.L.'s philosophy and approach I hope you will consider donating an additional amount, by supplementing your membership fee.

I am willing to donate: yes no

$5,000 $2,500 $1,000 $500
Other

    

© 2016  The Coalition to Extend Life    1717 K St. NW #600  Washington, DC 20036   202-445-4876
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