Personal Information

This questionnaire is designed to be filled out by anyone and everyone who is actively involved in iboga/ine production, treatment or research. Please be clear in providing your association to the community in the field below. This is not legally binding you into membership, which will be instituted over the course of the coming year.

* 1. Your Name

* 2. Organization

* 3. Your Work With Ibogaine

* 4. Email