life_passages

Life Passages 2013 Registration

Your First and Last Names

First and last names

Phone Number

XXX-XXX-XXXX

Address

Number and Street

City

State

Zip Code

Email

Your email address

Confirm Email

The following information MUST be submitted to allow Judith to prepare your personal astrology chart for use in the class. By submitting this form you give Judith express permissions to use use this information for the stated purpose. NO INFORMATION WILL EVER BE MADE PUBLIC, SOLD, OR RELEASED.

Disclaimer: This course is not therapy, nor is it intended in any way as a substitute for therapy. Should emotional, psychological or physical issues become reactivated during this course, you are encouraged to consult with a qualified professional.

Please check this box to continue

I aggree to allow Judith to use the information herein

Date of Birth

DoB

Time of Birth

Please be as accurate as possible

Place of Birth

City, State, Country

After filling out the form, click the submit button and you will be taken to a confirmation page and then to PayPal. YOU DO NOT NEED A PAYPAL ACCOUNT TO USE PAYPAL PayPal accepts most major credit cards.