Your Legal Name (First / Last)

Your Mailing address

Your City/State (or Country) / Zip  

Your Date of birth:  (MM/DD/YEAR)

Your Daytime & Evening Phone Numbers

Your Time zone residing in

Your Email Address  (make sure this is correct.

Information about your Psychic work experience

Company Name

Dates Worked

Reason Left

Supervisor / Telephone Number

Additional company you work(ed) for

Dates Worked

Reason Left

 Supervisor/Telephone Number
Do you have a private practice?  How Many years? 

Have you been covicted of a Felony? 
Yes No

Check your applicable specialties
Psychic        Tarot      Spirit Guides           Medium/Channeling
Palmistry    Astrology  Numerology            Dream Interpretation

Runes         Angels    
Pendulum               Past Life Regression
Are you bilingual in any other languages?

If you own a computer, what type operating system?

Are you currently working for another Online Company or a 900 lines?
If there are any additional qualifications etc, please write below: