X-Message-Number: 16852 From: "Trygve Bauge" <> Subject: Suggested: Suspension request registration form. Feedback requested. Date: Tue, 3 Jul 2001 19:03:34 +0200 This is a multi-part message in MIME format. ------=_NextPart_000_000F_01C103F2.DBB621C0 Content-Type: text/plain; charset="iso-8859-1" To cryonet: I am working on setting up a standard request form for use in handling post mortem requests for cryonic suspensions. I am looking for suggestions as to what it might be of value to include in such a form. Please submit suggestions to me. Sincerely, Trygve Bauge To Elizabeth, this is a draft, I am posting it to cryonet to get some feedback, once I have received some feedback I will upgrade this form and resend it to you. Please do not fill in the attached form yet. Just look at it and start getting together the information requested. In a day or two I will mail you the upgraded form and ask you to fill it in and and then to e-mail the filled in form back to me, so that I better can assist you. Sincerely, Trygve Bauge ------------------------ Post mortem requests for cryonic suspension. Request registration form. Please answer the following questions, so that I better can assist you: 1. The date and year and location when this form is filled out: 2. Who do you wanted suspended: First name:...... Middle name: ........ Last name: ........... When did this person die: ........... Where did this person die: .............. What did this person die from: .................. Did this person have any deadly contageous diseases: (aids, tuberculosis etc...) What contageous diseases did it have at the time of death: ..................... How old was this person when it died: ............ What nationality did this person have at the time it died: ............ What was the person's social security number/national I.D. number: ....... When was this person born: .......... Where was it born: ....... What was its nationality at birth: ........... What was the persons last address while alive: ..... Street: ... City: ....... State: ...... Zip code: ...... Country: ......... What line of work did the person have: ............ What was its last job: ............ Where did it work before it died? ............. What was the persons net worth at the time of death: .......... Did the person you want frozen have any life-insurance policy that would cover any of the expences of a cryonic suspension? ............. What is the insurance policy number? ........ At what insurance company is the policy: What is the amount of the insurance. Please submit a photo copy of any such insurance to: Trygve Bauge Life-Extension Systems P.o.b. 59, Hovseter, N-0705, Oslo, Norway. The person you want frozen, where is this person now: (Home/Hospital/Mortuary/Graveyard etc.......) Address of where this person is now: ........ Hospital suite #, mortuary storage # or Graveyard lot number: ..... Street: ... City: .... State: Zip code: ... Country: ..... Who is the person to contact at the location above: (doctor/mortician/undertaker etc..) Name of contact person: What is the phone of said contact person: What is the name of the doctor that signed the death certificate: ......... What is the phone number of said doctor: ............... Please photocopy the death certificat too, and send that by regular mail to Trygve Bauge, Life-Extension Systems. P.o.b. 59 Hovseter, N-0705 Oslo, Norway. 3. Who is the nearest next of kin to the person that you want frozen? ...... (Nearest kin is the spouse if married, otherwise the kids, if no spouse and no kids then the parents and then the siblings, otherwise a long time unmarried mate or nearest distant relative.) Spouse name: Phone number for the spouse: Adress for the spouse: Street, City, State, Zip, Country Age of the spouse: ............ How many kids did the person you want frozen have: .......... Name, age and phone number of each kid: name ................. age: ............ phone: ............ name ................. age: ........... phone: ....... Are the parents of the people you want frozen, still alive? .......... What are their names, ages and phone numbers: mother's name ............ age: ................. phone: ....... father's name: .............. age: ................. phone: ......... How many siblings did the person you want frozen have? What are the names, ages and phone numbers of the persons siblings: name: .......................... age: ................. phone: .......... Does the nearest kin know that you want the person frozen? Has the nearest kin (the spouse, all the kids, the parents or the siblings) given written permission for you to freeze the person you want frozen? Have at least 2 sane adult human beings signed on the permission that they have witnessed that the next of kin has signed the above permission and that the latter was mentally alert and of a sound mind when it signed and that it voluntarily signed. Please submit a copy of such a written, dated, signed and attested permission to Trygve Bauge Life-Extension Systems P.o.b. 59 Hovseter, N-0705, Oslo Norway 3. Then a little about yourself: What is your relationship to the person you want frozen: ........ Your first name: ........ Your middle name: ....... Your last name: ....... Your e-mail address: .... Your phone number at home: ..... Your phone number at work: ..... Your mobile/cellular phone number: ........ Your mailing address: ..... Street: ..... City: ..... Zipcode: ..... Country: ..... Your age: ...... Your present nationality: .... Your nationality at birth: ..... Your place of birth: ....... Your date of birth: ........ Your social security number/National I.D. number: ....... Your line of work: ............ Name of company you work for: ........ Your annual income: ..... Your net worth: ....... Your monthly income: .... Your monthly living expenses: housing, food, clothing etc.: .... Your monthly surplus. What you can can afford to spend (on cryonics etc.) each month without getting into economic distress.: .......................... Your education: ......... What languages do you speak: .......... Legally speaking: Are you an adult in full charge of yourself or do you have a guardian? Do you have any mental illnesess: ......... Do you use mental medication: ......... Have you ever been committed to a mental hospital: ........ How long have you been interested in cryonics: ........... When did you first hear of cryonics: ...... When did you first consider having the above person frozen: ... Who did you first mention the above desire to: ..... When did you decide to have the above person frozen: ..... Have you discussed this with the next of kin?: ........ Has the next of kin given you a written, dated and signed permission to have the above person frozen?: ...... Please mail a copy of said permission to: Trygve Bauge Life-Extension Systems P.o.b. 59, Hovseter N-0705, Oslo, Norway. Cryonic suspensions cost a lot of money: (See separate overview over costs here in Norwaay) As a comparison: Suspension after post mortem sign up costs (total one time fee of) USD 35,000 at C. I. plus the cost of having the body frozen elsewhere and delivered to C.I. in Michigan. But no monthly or annual costs thereafter. If C.I. does not accept the patient, it is more expensive to set up one's own facility. Full body suspension might easily cost USD 45,000 plus USD 1,000 a month. The above costs could be split on 4 to 6 patients, but would initially have to be covered by the first client. The monthly expenses could instead be covered by a onetime upfront investment of USD 200,000 or USD 35,000 per patient. Shipping and storage of just the head might easily cost USD 28,000 plus USD 500 a month. The above costs could be split on 7 patients, but would initially have to be covered by the first client. The monthly expenses could instead be covered by a onetime up front investment of USD 100,000 or USD 14,000 per patient. Shipping and storage of just the brain might easily cost USD 14,000 plus USD 250 a month. The above costs could be split on 20 patients, but would initially have to be covered by the first client. The monthly expenses could instead be covered by a onetime up front investment of USD 50,000 or USD 2,500 per patient. As far as just storing 10 to 20 cell samples, this could probably be done even cheaper at companies like Cells-4-life. The above costs are based on storeage in liquid nitrogen dewars or in electrical cryo freezers. There are also the additional costs of local suspension and/or assistance from local undertaker freezing the body, and making this ready to be shipped. If the patient has been dead more than 24 hours, we would reccommend a straight freeze. Otherwise, if the patient has just died or has not died yet, there is also the option of a more expensive suspension procedure aimed at reducing frost damage. Such a procedure might easily cost from USD 5,000 to USD 50,000 dependent upon the quality and professionals involved. Who are going to pay for the suspension, shipping and long run storage? : ........... How are these going to pay for it: ................ Do you have the money on cash now? .............. Do you have to borrow money to pay for the cryonic suspension? ............. Who are you going to borrow from? .................. What will you use as collateral to service the above debt?: ........... What will be your monthly payments on said loan? ............ Can you afford to service such a loan, and keep up the monthly charges above? ..... Please submit a letter from the bank acknowledging that you have the above money on hand or that you have a line of credit for the above amounts. Submit a copy of such a bank statement to: Trygve Bauge, Life-Extension Systems. P.o.b. 59, Hovseter, N-0705, Oslo Norway. Will you still have enough money to live on? ......... How much money will you still have to live on a month? ........... Do you really want to go ahead with this cryonic suspension? ...... Are you sure you do not want to use the money on something else? .......... If the person just died within the last 24 hours (or last few days): Do you want to pay for having him frozen right a way? ...... If that is what you want, then I suggest you get him frozen locally and immediately in the best possible way you can afford. I might be able to put you in touch with a team that can fly out and assist you. Once you have frozen him, then go for a walk, get a good meal, get a good nights sleep, before deciding what to do next and before deciding vwhether or not to take on the expense of long run storage. If the person has been dead for some time: Please go for a walk, eat a good dinner, get a good nights sleep, and then ask yourself the questions again. If you still want to get it done, then get in touch. 4. What have you done so far to get the above person frozen? Who have you talked to, written to or met and nspoken to, and when? please fill in the above list of people you have contacted in the order you contacted these: date, who you contacted, their phone number and or e-mail .... ... .. .. 5. Who else do we have to contact to get the permission to (dig up,) pick up, freeze, ship and store the above person: Please list local authorities, contact persons and phone number. Local mortuary that is willing to assist: ......... Local coronor: ....... Local police: ........... Local office deciding whether or not to permit exhumations: ........... Local hospital: ......... Local church: ............ 6.Please list other useful local contacts: Local cryonisists: ....... local suppliers of dry ice: Local building supply store for supplies to build a dry ice box: ......... Local carpenter to build a dry ice box. 7. Other international cryonics contacts: Cryonic patient organizations: ACS etc. Cryonic storage providers: Alcor and C.I. etc. Dewar manufacturers. ... manufacturers of small mobile liquid nitrogen plants: ..... 8. Useful contacts here in Norway: Trygve Bauge: Business parks: Building supply stores that sell supplies for building dry ice boxes. Carpenter: Liquid nitrogen suppliers: Dry ice suppliers: Lawyer willing to serve as a agent for cryo patients and their families: ------------- Ps. the above is just a draft. I am posting it to the cryonet and asking for input, then I will upgrade it, then I will ask you to fill in all the information requested above. Sincerely, Trygve Bauge ------=_NextPart_000_000F_01C103F2.DBB621C0 Content-Type: text/html; [ AUTOMATICALLY SKIPPING HTML ENCODING! ] Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=16852