Register your Experience with IANDS

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You may print this form and fill it out by hand and mail it back, or you may contact the IANDS office to get a paper copy sent to you to fill out.  We would prefer to get an electronic version to save having to retype things.  If you are trying to save connection time, you can, off-line, figure out what your responses would be and type up your experience description.  Then go back on-line and quickly answer the questions and paste in the description.  If that doesn't work for you, you can send us a paper copy of your answers and e-mail us the description, indicating in the e-mail that the paper copy is coming. 

Most fields below are required.  Please fill in as much detail as you can






(required)
Best time to call:
(If you want us to e-mail you a copy of your NDE narrative that you submit, you'll have to give us a valid e-mail address.  Otherwise, we need the telephone numbers and e-mail address in case any problems arise.  Your furnishing this information will not lead to telemarketing calls nor spam.  Follow this link to view our strict privacy policy (opens in a new window).)

 

IANDS may publish my experience.... (Permission does not guarantee publication).  Specify permission for each:

In IANDS' newsletter, Vital Signs
(sent to all members of IANDS, but also issues of Vital Signs may be purchased by contacting the office, and soon at book stores)




On the Internet
(computer World Wide Web.  If we publish this on the web, anyone may easily copy it.)
In any other IANDS approved media/publication


In the event that a researcher desires to talk with me, I wish:

 

EXPERIENCE SUMMARY

years

1. Your condition during the experience:

 
 
 
 

2. Circumstances of the experience (check all that apply):

     
     
     
 

3. Your status of health after the experience:

4. Your status of health now:

5. At the time, did you consider the contents of your experience:

6. Did your experience include (check all that apply):

   
   
   
   
   
   
 
 

7. Have you experienced changes in any of the following resulting from the experience
(check as many as apply):

healing or psychic abilities
 

8. Have these changes been:

9. Has your life changed specifically as a result of your experience? 

10. Over time, did your after effect:

13b.  Your religious background:

14. Your sex:

15. Your race: (check as many as apply):

Questions 18 through 27 relate only to NDEs that are combat-related, as specified in Question 2.  They aren't shown unless you indicate in Question 2 that your experience was combat related (unless your browser doesn't support hiding them).

Skip to Question 28 if your experience was not combat-related.

28. Describe your experience

Submitting this information to IANDS means you agree with the following: I wish the account of my experience to be placed in the IANDS archives.  I understand that it will be coded for anonymity and may be read by students or researchers who have been approved in accordance with IANDS' policies for use of the archives.  My account may be excerpted or used in full (if I have given permission), or data may be drawn from it in conjunction with any responsible study or project, including but not limited to classroom presentations, lectures or educational programs on near-death studies, or presentations at a professional conference; or as part of an academic paper, thesis or dissertation; or as part of an article for a professional journal or other responsible periodical, or in a book. My name will not be used unless I have given express permission to do so.  I also realize that my account may be edited for publication to remove references that might identify me or other people or institutions, and for grammar and spelling.

We suggest that you copy the narrative you typed in or even this whole form into your computer's clipboard, so that if something goes wrong, you won't have lost all your work.

If you have trouble submitting this form or you don't get a "Thank You" message after you press the submit button, first look for any errors listed at the top of the form. If you are still having problems, contact us.


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Last Updated ( Wednesday, 09 February 2011 23:53 )