Your Legal Name (First / Last)

 
Your Mailing address

 
Your City/State (or Country) / Zip  

 
Your Date of birth:  (MM/DD/YEAR)

 
Your Daytime & Evening Phone Numbers

Your Time zone residing in

 
Your Email Address  (make sure this is correct. ) 

Information about your Psychic work experience

Company Name

 
Dates Worked

 
Reason Left

 
Supervisor / Telephone Number

 
Additional company you work(ed) for

 
Dates Worked

 
Reason Left

 
 Supervisor/Telephone Number
Do you have a private practice?  How Many years? 

Have you been covicted of a Felony? 
Yes No

Check your applicable specialties
 Psychic        Tarot      Spirit Guides           Medium/Channeling
Palmistry    Astrology  Numerology            Dream Interpretation
Runes         Angels     Pendulum               Past Life Regression
        
Are you bilingual in any other languages?

If you own a computer, what type operating system?


Are you currently working for another Online Company or a 900 lines?
If there are any additional qualifications etc, please write below:

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