*Name:
Name and Surname

*Email:
preferably not Hotmail or Yahoo mail, who often block messages

Telephone:
please include country and city codes

Postal Address:

Birth date:
dd/mm/yyyy or in words

Birth place:
city, town or village of birth

Country of birth:

Birth time:
closest known - include am/pm and say how accurate it is

Highest educational qualification:
also include any diplomas you may have

Have you studied astrology formally?
If yes, give details of course and/or teacher and for how long you studied, as well as if you qualified

If you are self taught, please give details of your main sources you studied and for how long:

Why do you want to study astrology?

Why have you chosen this course instead of others?

How did you hear about this course?

At this stage, do you plan to study through to the Diploma?

Do you hope to be a professional astrologer in the future?

Do you hope to use astrology to complement your existing profession?
Please give details

If you said no to the last two questions, how do you plan to use astrology?

Payment by: Credit card EFT (South Africa only)

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