Print out this page on your printer and write in the information. The birthdata is used to set up your birthchart. Include a check for $10.00 (MN residents, $10.78) to "BPI" to cover costs (please use US funds). Mail to the address at the bottom of this page. Allow 4 weeks for deliver.
All information you provide us is strictly confidential. The email address or phone number is in case there's a mix-up in communications that we need to clear up -- retrograde Mercury does happen sometimes!
Email address and/or phone number (optional):
Date of birth (month, day, year):
Time of birth (time, AM/PM, timezone):
City of birth (city, state/country):