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Please fill out this form, print it and include together with
your cashier's checks or postal money order for $39.

*No personal checks accepted.

Please mail this form together with a payment to:

Dr. Michael Vanderpool
Rural Route 5, Box 60,
Marshall, MO 65340
U.S.A.

Name:

Postal Mail or E-mail
Address Qabbalistic Angels
Astrology Horoscope to be
delivered to:

Date of Birth:

Time of Birth:

City and State/Region of
Birth:

Country of Birth:

Questions:

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2.________________________________________

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3._______________________________________

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