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ASTROLOGY READING MAILFORM
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PLEASE ENTER THE FOLLOWING DATA :

As the major portion of my time goes into preparing the reading and penetrating the data provided by you, it is essential that you
send payment in advance
and also specify if you wish express courier service, extra, as outlined on my wwwsite.

The readings are given when it is most auspicious for your birth star, the lunar mansion your Moon occupies in your birth chart. Any questions concerning any of the above kindly contact me under: ompalace@fastmail.fm or 519-372-2216. You may also read the FAQ section to clarify commonly asked questions.

Name at birth :
Name today :
Date of birth :
(yyyy) (mm) (dd)
Place of birth :
Longitude if known :
(°) (') (")
Latitude if known :
(°) (') (")
Time of birth :
(hrs) (') am pm
Address :
Email :
Phone :
Skype name (if you want consultation by Skype) :
Profession :
Specific Questions/Concerns
 

The information you have supplied above will not be used in any way other than intended in this mailform.
Your personal data will not be sold to or exchanged with any third parties.

     
 
     
     
     
     
     
     
     
     
     
       
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