Astro Robin - Astrology Robin's Way
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Gold Member Data Form



1547 Palos Verdes Ste. 280, Walnut Creek CA 94597
Fax: 925-465-1009 Orders@AstroRobin.com
This form is for Gold Member Birth Data

Gold Membership $17.00/mo

Birth Chart Information

Name: (Names are used inside reports)

Gender: Male Female

BirthDate:


Please enter actual time per birth certificate, or other record (for the most accurate report)
BirthTime:
: OR, if you don't know the birthtime, Check here:

Birth City:

Birth State: (or Country)
Your Contact Information in case we have a problem with your order:
Name: Email:
Phone: time zone where you live :

Last Updated: 07, 31, 2008 at 3:40 PM