Heroine's Journey Registration

Soul Journey Astrology Self-Study Course Registration

with Judith Goldberg - www.souljourneyastrology.com
Which Course Are You Registering For?*

The Heroine's JourneyLife Passages: Karma to DharmaMy Three Suns
Full Name*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
The following information MUST be submitted to allow Judith to prepare your personal astrology chart for use in the class. By submitting this form you give Judith express permissions to use this information for the stated purpose. NO INFORMATION WILL EVER BE MADE PUBLIC, SOLD, OR RELEASED.

Disclaimer: This course is not therapy, nor is it intended in any way as a substitute for therapy. Should emotional, psychological or physical issues become reactivated during this course, you are encouraged to consult with a qualified professional.
I agree to allow Judith to use my Information*

YesNo
I promise to keep confidential all information shared by participants.*

Yes
Date of Birth*

MonthDayYear
Please provide the most accurate birth time available to you.
Time of Birth*

:HourMinutesAM/PM Option
Source of Birth Time*
Enter City, State and Country of birth. Also, if there is more than one county for the city, enter the county.
Place of Birth*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
County of Birth
Enter County if more than one for this city
Is there anything else you would like Judith to know or other comments you would like to share?
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Thank You for Registering. I'm looking forward to having you in the course!

After you submit this form you will be sent to paypal to pay for your course. You will be given the option of paying with paypal or by credit/debit card outside of paypal.
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Soul Journey Astrology Self-Study Course Registration