Destiny Reading (BaZi)

Registration Form

First Name *

Last Name *

Date of Birth * ( for eg: 15/08/1993 )

Day

Month

Year

Time of Birth

Hour

Minute

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Gender *

Male

Female

Phone Number *

Area Code

Phone Number

E-mail *

Family Details

Name 1

Relationship with Name 1

Date of Birth ( for eg: 15/08/1993 )

Day

Month

Year

Time of Birth

Hour

Minute

Name 2

Relationship with Name 2

Date of Birth ( for eg: 15/08/1993 )

Day

Month

Year

Time of Birth

Hour

Minute

Name 3

Relationship with Name 3

Date of Birth ( for eg: 15/08/1993 )

Day

Month

Year

Time of Birth

Hour

Minute

Mode of Consultation *

Online via Skype or Face time

At your Location

In Our Office

Comments ( If Any )

Payment Details A: Online via Skype or Face time

Price: USD 308 for 45 minutes
Time Requested: Let us know what works for you,we are flexible

B: At your Location

Price: Ask for a quote
Time Requested: Let us know what works for you, we are flexible

C: In Our Office

Price: USD 108 for 45 minutes
Time Requested: 10 am to 5 pm IST (+5.30 GMT)

* Disclaimer: Time, Date, and Venue to be decided by both Parties .
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Destiny Reading (BaZi)

Registration Form

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