Health for Longevity Membership Form

The International Health for Longevity Annual Membership

Be Part of the Story – Register Today! Join a growing international community committed to extending healthy lifespan through research, education, and advocacy. Please see our website membership tab: https://h4l.ca/membership for more information.
CONTACT INFORMATION
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website

Membership Plan*

StudentsFor students in any field

$150.00CAD for each year

Physicians and Healthcare ProfessionalsFor medical practitioners

$300.00CAD for each year

CompaniesFor businesses

$600.00CAD for each year

Consents & Agreements
Terms and Conditions

I confirm that I am 18 years of age or older and agree to become a member of Health for Longevity (H4L). I understand that my annual membership fee supports the organization’s mission and entitles me to membership benefits including communications, event passes, and discounts.

I acknowledge that H4L may contact me via email with updates related to membership, events, and organizational news. I can unsubscribe at any time.

I understand that my personal information will be collected, stored, and used solely for the purposes of managing my membership and communicating with me as a member. H4L will not share or sell my personal data to third parties without my consent, except as required by law.

By submitting this form, I consent to the above terms and to the processing of my data in accordance with Health for Longevity’s privacy practices.
Confirmation*

I agree to the terms and conditions of Health for Longevity.
Completing this form automatically subscribes you to our newsletter with updates on our event and exclusive offers. By checking this box, you understand that you can unsubscribe at anytime.

I understand
Should be Empty:

The International Health for Longevity Annual Membership