Name:

Date/Time of sighting

How many objects?

Size, Shape, characteristics and distance of objects?

Did you or others have any missing time ?
yes No

If you have had missing time please explain ?

Please explain your sighting in detail .

Were there any other witnesses or if there was any physical or trace evidence?
Yes No

If yes please explain.

Electromagnetic effects?
Yes No

Animal reactions ?
Yes No

If yes to one of the above two questions please explain ...

Were there any agencies involved with this sighting including but not limited to Government agencies
Yes No

If another agency was involved please explain the circumstances of the involvement.

Would you like to be contacted by an UFOII Field Research representative?
Yes No

Location of sighting.