CC Experiencer Application Form – CC Experiencer Group

CC Membership Number [on your registration email from CC]*

Please use the email you joined CC with*

Enter email again *

Alternative Email*

First Name*

Last Name*

Age*

under 1818-3031-4950+

Gender*

FemaleMale

Phone Number

What country do you live in?*

Zip / area code / postcode*

Have you discussed your experience with anyone else?*

yesno

Are you a member of any other (UFO) support group, e.g. MUFON?*

yesno

If Yes, please enter the name of the support group

Very briefly – describe your experience that has changed your life*

Please provide a drawing or photo of your experience if possible. A simple drawing is fine.

Terms and Conditions Keeping Privacy and Security *

I will keep all information shared by other members of this group private and confidential. I agree not to discuss others’ personal information outside this group. 
! will not record any data or discussions on this website, including any Video conferencing e.g. zoom meetings, written information etc.

*𝘛𝘩𝘦 𝘥𝘦𝘤𝘪𝘴𝘪𝘰𝘯𝘴 𝘰𝘧 𝘵𝘩𝘦 𝘔𝘰𝘥𝘦𝘳𝘢𝘵𝘰𝘳𝘴 𝘢𝘳𝘦 𝘧𝘪𝘯𝘢𝘭 𝘪𝘯 𝘳𝘦𝘭𝘢𝘵𝘪𝘰𝘯 𝘵𝘰 𝘢𝘭𝘭 𝘤𝘰𝘯𝘧𝘭𝘪𝘤𝘵 𝘳𝘦𝘴𝘰𝘭𝘶𝘵𝘪𝘰𝘯*

I understand and accept the terms and Conditions

Username*

Password*

Enter password again*