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Area Representative Form

January 2001 - January 2002

Today's Date: Enter 4 digit year

First Name: MI:

Last Name:

Address: Apt. #:

City: State: Zip:

Email Address:

Experience:

Answer the following (1=absolutely... not 3=neutral...5=absolutely yes) 17 Questions:

1. I consider myself open-minded:

2. I base judgments on intuition:

3. I am skeptical:

4. I believe in ghosts:

5. I have had experiences with ghost-phenomena:

6. I want to be a paranormal investigator to make it a career:

7. I am easy to get along with:

8. I have had friends who have claimed to have had ghost encounters:

9. I study the occult:

10. I am well versed in science:

11. I have a genuine interst in paranormal investigating:

12. I am familiar with the scientific method:

13. Religion should play a role in investigations:

14. I respect the judgements of others:

15. I respect others of different background, race, sex or creed:

16. The first priority in an investigation is:

17. The first priority of my organization or myself is to:

Pleas e explain your experience with ghost-phenomena in 120 words or less: