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Telephone : 082 651 5368
PO Box 946, Highlands North, 2037
Email: ltl@ltlhealing.co.za
Web Address: http://www.ltlhealing.co.za
Application Form

Fill in the necessary details and e-mail it to LTL Healing, or print it out and fax it to me.
Fields marked with an asterisk (*) are compulsory.
Fields marked with two asterisks (**) are compulsory for astrology readings and reports.

Personal Information
*Title : Mr. Miss. Dr. Prof. Mrs. Ms. Other
*First Name:
*Last Name:
*Date of Birth: Day:
 Month:
 Year:
**Time of Birth: Hour:
 Minutes:
 Seconds:
 AM / PM

Time Zone:

 Time Unknown :
**Place of Birth: Town/City:

Country:
**Current Location: Town/City:

Country:
Marital Status: Married Single Divorced Widow

Partner's Information (Astrology Readings and Reports only)
This information is only required if you are requesting a Compatibility Reading or a Compatibility Report. Enter the details of your partner, whether this is a husband, boyfriend, parent, child, etc.

**First Name:
**Last Name:
**Date of Birth: Day:
 Month:
 Year:
**Time of Birth: Hour:
 Minutes:
 Seconds:
 AM / PM

Time Zone:

 Time Unknown :
**Place of Birth: Town/City:

Country:
**Current Location: Town/City:

Country:

Contact Information
One contact number is compulsory so that you can be contacted regarding your session and/or delivery of your report.

Telephone Number (Home):
Code: No: 		Telephone Number (Work/Other):
Code: No:
Cellular Number:

Sessions Required
Indicate the sessions you require:

Astrology Reading Reiki Resonance Repatterning Family Constellation Jin Shin Jyutsu
R800.00 (1 and a 1/2 hours) R300.00 (1 hour) R500.00 (1 - 1 and a 1/2 hours) R500.00 (1 - 1 and a 1/2 hours) R300.00 (1 hour)

Astrology Reports Required
Indicate the astrology reports required:

Natal Reading Compatibility Reading Numerology Reading My Year Ahead Reading Life Lesson Reading Solar Return Reading
R300.00 R300.00 R150.00 R400.00 R250.00 R350.00

Book Orders
Indicate the books you wish to purchase:

Getting to No Me Living Life Consciously
R120.00 R250.00

Please contact LTL Healing for banking details and fax number.