Personal Details

Name:

Email Address:

Experience Details

1. Have had unexplainable missing or lost time of one hour or more.
   Yes No
   
   

2. Have been paralyzed in bed with a being in your room.
   Yes No
   
   

3. Have unusual scars or marks with no possible explanation on how you received them (small scoop indentation, straight line scar, triangular marks, scars in roof of mouth, in nose, behind or in ears, etc.)
   Yes No
   
   

4. Have seen balls of light or flashes of light in your home or other locations
   Yes No
   
   

5. Have a memory of flying through the air which could not be a dream, or many dreams involving flying.
   Yes No
   
   

6. Have a strong "marker memory" that will not go away (i.e.: an alien face, an examination, a needle, a table, a strange skinny baby, etc.)
   Yes No
   
   

7. Have seen beams of light outside your home, or come into your room through a window.
   Yes No
   
   

8. Have had many dreams of UFOs, beams of light, or alien beings.
   Yes No
   
   

9. Have had a shocking UFO sighting or multiple sightings in your life.
   Yes No
   
   

10. Have a cosmic awareness, an interest in ecology, environment, vegetarianism, or are very socially conscious.
    Yes No
    
    

11. Have a strong sense of having a mission or important task to perform, sometime, without knowing where this compulsion is coming from.
    Yes No
    
    

12. Have a secret feeling that you are "special" or "chosen," somehow.
    Yes No
    
    

13. Have had unexplainable events occur in your life, and felt strangely anxious afterwards.
    Yes No
    
    

14. Have had several strange psychic experiences - such as knowing that something is going to happen before it happens.
    Yes No
    
    

15. For women only: Have had false pregnancy or missing fetus. (pregnant, and then not)
    Yes No
    
    

16. Have awoken in another place than where you went to sleep, or don't remember ever going to sleep. (i.e. waking up with your head at the foot of your bed, or in your car)
    Yes No
    
    

17. Have had a dream of eyes such as animal eyes (like an owl or deer), or remember seeing an animal looking in at you. Also if you have a fear of eyes.
    Yes No
    
    

18. Have awoken in the middle of the night startled.
    Yes No
    
    

19. Have strong reaction to cover of Communion or pictures of aliens. Either an aversion to or being drawn to.
    Yes No
    
    

20. Have inexplicably strong fears or phobias. (i.e. heights, snakes, spiders, large insects, certain sounds, bright lights, your personal security or being alone).
    Yes No
    
    

21. Have experienced self-esteem problem much of your life.
    Yes No
    
    

22. Have seen someone with you become paralyzed, motionless, or frozen in time, especially someone you sleep with.
    Yes No
    
    

23. Have a memory of having a special place with spiritual significance, when you were a youngster.
    Yes No
    
    

24. Have had someone in your life who claims to have witnessed a ship or alien near you or has witnessed you having been missing.
    Yes No
    
    

25. Have had, at any time, blood or strange stain on sheet or pillow, with no explanation of how it got there.
    Yes No
    
    

26. Have an interest in the subject of UFO sightings or aliens, perhaps compelled to read about it a lot.
    Yes No
    
    

27. Have an extreme aversion towards the subject of UFO's or aliens - don't want to talk about it.
    Yes No
    
    

28. Have been suddenly compelled to drive or walk to an out of the way or unknown area.
    Yes No
    
    

29. Have the feeling of being watched much of the time, especially at night.
    Yes No
    
    

30. Have had dreams of passing through a closed window or solid wall.
    Yes No
    
    

31. Have seen a strange fog or haze that should not be there.
    Yes No
    
    

32. Have heard strange humming or pulsing sounds, and you could not identify the source.
    Yes No
    
    

33. Have had unusual nose bleeds at any time in your life. Or have awoken with a nose bleed.
    Yes No
    
    

34. Have awoken with soreness in your genitals which can not be explained.
    Yes No
    
    

35. Have had back or neck problems, T-3 vertebrae out often, or awoken with an unusual stiffness in any part of the body.
    Yes No
    
    

36. Have had chronic sinusitis or nasal problems.
    Yes No
    
    

37. Have had electronics around you go haywire or oddly malfunction with no explanation (such as street lights going out as you walk under them, TV's and radios affected as you move close, etc.).
    Yes No
    
    

38. Have seen a hooded figure in or near your home, especially next to your bed.
    Yes No
    
    

39. Have had frequent or sporadic ringing in your ears, especially in one ear.
    Yes No
    
    

40. Have an unusual fear of doctors or tend to avoid medical treatment.
    Yes No
    
    

41. Have insomnia or sleep disorders which are puzzling to you.
    Yes No
    
    

42. Have had dreams of doctors or medical procedures.
    Yes No
    
    

43. Have frequent or sporadic headaches, especially in the sinus, behind one eye, or in one ear.
    Yes No
    
    

44. Have the feeling that you are going crazy for even thinking about these sorts of things.
    Yes No
    
    

45. Have had paranormal or psychic experiences, including intuition.
    Yes No
    
    

46. Have been prone to compulsive or addictive behavior.
    Yes No
    
    

47. Have channeled telepathic messages from extraterrestrials.
    Yes No
    
    

48. Have simply heard an external voice in your head, speaking to you, perhaps instructing or guiding you.
    Yes No
    
    

49. Have been afraid of your closet, now or as a child.
    Yes No
    
    

50. Have had sexual or relationship problems (such as an odd "feeling" that you must not become involved in a relationship because it would interfere with "something.")
    Yes No
    
    

51. Have to sleep against the wall or must sleep with your bed against a wall.
    Yes No
    
    

52. Have a fear that you must be very vigilant or you will be taken away by "someone."
    Yes No
    
    

53. Have a difficult time trusting other people, especially authority figures.
    Yes No
    
    

54. Have had dreams of destruction or catastrophe.
    Yes No
    
    

55. Have the feeling that you are not supposed to talk about these things, or that you should not talk about them.
    Yes No
    
    

56. Have experienced many things in this list, and recall your children or parents speaking of similar experiences on occasion.
    Yes No
    
    

57. Have tried to resolve these types of problems with little or no success.
    Yes No
    
    

58. Have many of these traits but can't remember anything about an abduction or alien encounter.
    Yes No