Psychological Astrology Level 1(Certificate Course)Student Intake Form Name * First Name Last Name Email * Current Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Date of Birth * MM DD YYYY Place of birth & Time of Birth, (city, state/province, country) * Please describe your previous astrological experience and level of study. * Please select your primary reason for taking this course. * Because I have a general interest in astrology for my own learning Because I want to specialize in Psychological Astrology Because I work as a therapist Because I am new to astrology and want to learn the basics Please add any additional information you want to share about why you're interested in taking Psychological Astrology Level 1 Thank you for your submission! We look forward to having you as a student in our course!