Full name

Address

City and Postal (Zip) Code

Country

Your email address

Your telephone number

Internet offer Yes No

In case of internet offer: email address to send Word 97 file to (if different from your email address)

Day of birth                              Month of birth                     Year of birth

Hour of birth (please fill in 4 P.M. as 16.00) 

Place of birth (if it is a small town, please fill in the nearest larger town or city)

I hereby register for the Correspondence Course Applied Vedic Astrology and agree to the Course Regulations (see below).