Supporter questionnaire

On this page you will find the Supporter questionnaire for the Optimum Health. If you are interested in volunteering or contributing in any way to the Optimum Health, to help promote technologies for healthy longevity, please fill in this form. We would like to know a little about you, your skills, and your expertise. We appreciate your time and help. Fields with (*) are obligatory.

First name *

Last name *

E-mail *

Phone number *

Skype handle

City *

Country *

Education, titles *

Your company and position *

Your professional skills *

Your skills outside of professional field *

Knowledge, skills and abilities you would like to acquire *

Which languages do you speak fluently? *

Your hobbies? *

How did you find out about the Optimum Health? *

What do you like about the idea of healthy longevity? *

Choose the form of collboration that fits you best (multiple answers) *

Volunteer help in your professional domain

Volunteer help in organizational processes

Ready to support the organization with regular donations

Ready to volunteer to acquire new skills

Ready to share some useful contacts, or to help with networking

How much time you could share to help the Optimum Health? (one answer) *

One hour a week, not more

2-3 hours a week

1-2 hours every day

More than 3 hours every day

After you click “Submit” your form will be sent to the Optimum Health administration for consideration. We will contact you to discuss possible ways to coordinate our efforts. Thank you very much for your interest to our work! We look forward to a healthier future for all.

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This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Math question * 4 + 0 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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Regional non-governmental organization Optimum Health

Supporter questionnaire

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Supporter questionnaire