Name:
Address (line1):
Address (line2):
City:	State/Province:
Country:	Postal Code:
Phone #:	Email:
Age:	Male Female
Education Level: High School Graduate College Graduate Post Graduate Degree
Degree(s) Earned:
Current Occupation:
Have you ever had what you consider to be a PSI paranormal experience? Yes No
If you answered yes, please describe your first PSI paranormal experience.
Do you feel that you possess any GESP abilities? Yes No If you answered yes, please describe what kinds of abilities you possess.
With respect to Parapsychology, what area are you most interested in? Lab Parapsychology Field Parapsychology
Have you ever been tested with respect to PSI abilities? Yes No
If you answered yes, please check the type of tests you have had:
Placement Test	Singles Test
Screened Touch Matching	Other	N/A
If you answered Other, please explain the nature of the test.
If you have never been tested, would you participate in a test if one was offered? Yes No
Are you interested in Anpsi studies? Yes No
Have you ever had a paranormal experience dealing with a haunting? Yes No
If you answered yes, please briefly describe your first experience with a haunting.
Please describe your most exciting/frightening/ outstanding experience with a haunting.
Do you belong to any organization dealing with any aspect of paranormal phenomenon? Yes No
If you answered yes, please list the organization with which you are affiliated.
What functions do you perform within each organization?
Please check the other areas of interest you may have. NDE (Near Death Experience) Photography EVP (Electronic Voice Phenomena) Witchcraft Tarot Cards Crystals Psychic Readings Astrology Numerology Other N/A
If you checked ÎOther', please list your other interests.
Do you read books regarding Parapsychology, Paranormal Research, PSI Abilities, Haunted Locations? Yes No
If you said yes, please list:
Have you ever had a psychic reading, tarot card reading, palm reading? Yes No
If yes, please list which one(s).
Do you still have readings performed? Yes No
Do you watch any television programs dealing with paranormal subject? Yes No
If you answered yes, please list to the best of your ability.
If you had the opportunity to learn more, would you take advantage of it? Yes No
Please check the opportunities you would be interested in. Classes Video Tapes Seminars/Lectures Audio Tapes Field Training Internship Books Other N/A
If you marked "Other", please describe what opportunities you would like to have available to you.
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