Rhine Research Center: Mysterious Short Story Submission Form

Personal Information

First Name *

Middle Name

Last Name *

Street Address *

Address Line 2

City *

State

Zip Code

Country *

Phone *

Email Address *

You must be 18 years or older to enter this contest. By clicking this box, you are affirming that you are at least 18 years of age. *

I am 18 years old or older

Information About Your Story

My story is: (optional)

Completely Fictional

Fiction, but based on a true event or experience

A description of an actual event

My story contains the following elements: (optional)

General Information

I have read and understand the official rules of this contest. I meet all of the necessary requirements and agree to abide by all rules for this contest. VIEW OFFICIAL RULES HERE *

I understand

There is a $20 fee to submit your story to this contest (you will be redirected to a payment site when you submit this form): *

I agree to provide the submission fee ($20.00)

Submit your story here. It should be use MS-Word format or a similar electronic format. The Rhine is not responsible for corrupted file submissions or files that are not readable. The file size should be under 2MB. *

DISCLAIMER: Submitting a story for this contest does not constitute a verification of psychic abilities or the validity of the content of your story. The Rhine Research Center does not validate psychic abilities and does not offer psychic counseling of any sort. This contest is for entertainment purposes.

Electronic Signature

By typing my name below and submitting this application, I am confirming that all of the information provided in this application is accurate to the best of my knowledge. I am also expressing an interest in participating in this activity sponsored by the Rhine Research Center.

I also confirm that I understand that although there is no such thing as complete privacy when it comes to using the internet, all information provided on this application will be considered confidential and will be securely maintained by the Rhine Research Center. The Rhine Research Center, and all of the employees and associates of this center will be held harmless in the event of an inadvertent breach of confidentiality.

Electronic Signature *

Date *

If you wish to pay by check, please contact the Rhine at 919-309-4600. Please reference the Rhine Mysterious Short Story contest and the amount of your payment.

I am interested in receiving additional information via email the Rhine Research Center, activities, and events.

Please add me to your mailing list.

All information is the sole property of the Rhine Research Center and cannot be reproduced or reused without the expressed written permission of the Rhine Research Center.

Telepathy (mind to mind communication)	Clairvoyance (knowledge about objects or events from a distance)
Precognition (information gained through time - typically about future events)	Remote Viewing (a specific form of Clairvoyance
Psychokinesis (mind-matter interaction: previously called telekinesis)	Out of Body Experience (OBE)
Near Death Experience (NDE)	Haunting, Apparitions, or Poltergeists
Mediumship (communication with spirits)	Reincarnation
Other Other