Personal Information
First Name
Last Name
E-mail
Age
Male Female
Address
City
State/Province
Zip/Postal Code
Country
Home Phone
Work Phone
Occupation
Native Language
How often do you currently recall dreams?
(a) rarely
(b) 1
/ month
(c) 1 / week
(d) 2-4 / week
(e) one / night
(f) 2-3 / night
(g) 4 or more
per night
How often do you currently have lucid dreams? (A lucid dream is one
where you know that it's a dream and guide it consciously.)
(a) never
(b) 1 / year
(c) a few a year
(d) 1 / month
(e) 1 / week
(f) 2-4 / week
(g) 1 / night
Incubation Results
All submitted results will remain confidential though they may be used
anonymously for statistical research. Beyond this, do you give permission to print your
dream and experiment results in the future?
(a) Yes,
using only my initials and city.
(b)
Yes, anonymously.
(c) No.
Record the following information for each dream:
Incubation Goal (one sentence):
About the Related Dream
Date
Time you went
to bed.
Time you
recorded dream.
Dream Title
Content:
Your insights / interpretation about the dream (please be concise):
Related waking events (please be concise:)
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