CONTACT PARANORMAL ZONE

CONTACT PARANORMAL ZONE

Do you have a personal paranormal experience that you would like to share and can document with written commentary, witness statements, photos or videos? If so, fill out and submit the form below. We will be in contact with you regarding the scheduling of an interview and the posting of the evidence of your encounter on the Jerry Pippin Show web site.

The Jerry Pippin Show will respect your privacy and your ownership rights of any material submitted. All material posted on this site will also be copyrighted by Jerry Pippin Productions and use by other parties of the material as presented on this site will be allowed only by written or e-mailed permission of both yourself and Jerry Pippin Productions. Your name and the names of any witnesses will be protected by pseudonym substitution at your request. Furthermore, by submitting the form below to Jerry Pippin Productions, you certify that you are the author or sole owner of the material being submitted. Jerry Pippin Productions may reproduce, distribute, publish, display, edit, modify, create derivative works and otherwise use the material for any purpose, in any form on The Jerry Pippin Show without compensation to you. And, you agree to indemnify Jerry Pippin Productions for all damages and expenses that may be incurred in connection with the material.

PARANORMAL ZONE INCIDENT REPORT SUBMISSION FORM

Name

City

State

Country

Phone Number required only if you wish to be interviewed.

E-Mail Address

Does this incident include one or more of the following events?
Ghost sighting
Poltergeist
Communication with the Dead
Telepathy
Telekinesis
Prophesy or Vision
Orbs or Unknown Lights
Remote Viewing
After Death Experience
Channeling
Dimensional Portals
Astral Travel
Time Travel or Traveler Encounter
Encounter with unknown animal or being
Other
If other, describe

When did the event occur?
Time
Enter a specific or approximate time the incident began or "unknown." If time is approximate, state "approximately."
Date
Enter a specific or approximate date the incident began or "unknown." If date is approximate, state "approximately."

How long did the incident appear to last?
Enter a specific or approximate time in minutes and/or seconds or "unknown." If time is approximate, state "approximately."

Check off what material you have available for our use:
Personal eye-witness account
Accounts of other witness or witnesses
Photos
Video

Do you wish to use a pseudonym for your own name or the names of witnesses?
Yes
No

Would you be interested in scheduling an interview with Jerry Pippin on the Paranormal Zone Show?
Yes
No

If you have a web site, what is the address?

Is there any information on this incident that you would like to provide at this time?
Limit of 20 lines. Send longer documentation direct to jerry@jerrypippin.com.

It is assumed that you agree with the statements made at the top of this page regarding the use of any materials provided by you to, or interviews conducted with you on, the Jerry Pippin Show. If not, any issues will be discussed with you when you are contacted either by e-mail or phone.