OOBE & NDE Interview Form

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Name
First Name
Last Name
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Instagram Handle
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Email
example@example.com
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Phone Number
Area Code
Phone Number
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Is English Your Native Language?
YESNO
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What Country Are You Located?
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What Did You Experience?Select one that resembles your experience:
Out Of Body Experience
Near Death Experience
Out Of Body Experience (Induced by Psychedelic Compounds)
Near Death Experience (Induced by Psychedelic Compounds)
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How Long Ago Was Your Experience?
Less then 12 months ago
1-3 years ago
4-10 years ago
10-20 years ago
20+ years ago
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Describe Your Story / Experience in a Nutshell?Please make sure you give us as much Details as possible
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How Was Your Overall Experience?From Traumatic to Mediocre-'meh' to Mind-blown Life-Transforming...
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Have You Published a Book?
YESNO
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Please Write Down Any Additional Social Media Links
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Ok
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Photo / Headshot (Optional)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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Do You Agree to this Basic Media Release as part of this Research Project?* This field is required.
YESNO
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I agree to Media ReleaseI grant permission to Tino Beth hereinafter known as the “Media” to use my image (photograph and/or audio/video) for use in researching supernatural phenomenon and Media publications including book publications, podcasts and social media content. I hereby waive any right to inspect or approve the finished recording or electronic content that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image. I am 20 years of age or older and I am competent to contract in my own name. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.
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You will be redirected to Calendly to book a call:Please message @QuantumFeedback on Instagram to let us know you've completed the application! Also If you need to speak to me Directly, reach me on IG @QuantumFeedback
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