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14 Ben Ami Street / Tel Aviv / 63565 / Israel
Kabbalistic Astrology Reading with Yael Yardeni
Request Form
Today’s date: _07/05/13_______
Contact Information (please print very clearly)
Name: _______ ___________________________________________
Mailing Address: ___
Home: ____________________________________________________
Work: ____________________________________________________
Cell: ____________________________________________________
Email: __ __________________________________________________
Are you a student of the Kabbalah Centre? Y / N
Name of your Kabbalah Instructor: _____RUTH BOUHANNA__________
Birth Information (VERY IMPORTANT – DATE, HOUR, AND PLACE OF BIRTH):
Date of Birth:___________________________________________________________
Please write the month in full letters: Example: January 1, 1960.
(If born in Iran please double check your birth date with the Persian calendar converter)
Hour of Birth: _______ __________________
AM / PM - Circle one
Please be precise as the accuracy of your reading depends on it.
If you do not know time of birth we can provide you with a short questionnaire that we use to determine time of birth.
Place of Birth: Country: _ ____________State: _____________City:__ __________
Please indicate the type of profile you desire: You will be schedule for one profile at a time.
***Chart exceeding it time will be charged an additional $72. This charge will occur after your chart reading.***
≤ Natal Chart AKA: Birth Chart (First time Chart reading with Yael Y) - @ 1 hour - $220
≤ Progression - @ 30 min - $115 (Every 14 months)
≤ Comparison (of you and another person) - @30 min - $115
DOB: _____________ HOB: _______________POB: _______________Current location:
_____________
≤ Infant/Child Chart (0-19 yrs. of age) - @ 45 min - $161
≤ Calculation of Time of Birth - $101
≤ Follow up questions/Chart Review (phone, email or Skype) -@30 min $115
≤ Location Charts, Solar Returns, Astrology dates suggestions, etc.-@ 30 min $115
Any particular issue you want to be addressed during the reading:
______________________________________
________________________________________________________________________________________________________
__________________________________________________________________________________
Payment Information:
Credit Card MASTER4CARD
VISA/MC/AMEX/DISC CARD#: _____________________________Exp Date:
__________________________
Purchaser’s Signature:
_______________________________________________________________________
You will receive a Complimentary CD of your chart reading at the time of your
session.
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