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Name
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First Name
Last Name
Email
*
example@example.com
Date of Birth
*
Date & Year
Time of Birth
*
Minutes Minutes
AM
PM
AM/PM Option
Is your birth time accurate?
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yes
no
don't know
If NO, do you have a range?
*This is important for the accuracy of your chart
Place of Birth
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City & State (or Country)
How did you hear about us?
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Everest Asher
Alchemist Kitchen
Other
If other, how?
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