All First Names (in Full) ________________________________

All Previous Last Names ______________________________

DOB Day_____ Month _____ Year ____ Age _____ Sex ____

Country of Birth _____________________________________

Time of Birth if known ________________________________

Do you require a general reading (yes/no)__________________

For a specific problem please give details __________________

__________________________________________________

Please enter a delivery address for the taped reading
_________________________________________________
_________________________________________________

Send cheques \ crossed Postal Orders for £30 within the UK
or $80 outside of the UK.
Made payable to :-
Anna G Stokes

207 Devonshire Rd
BOLTON
UK
BL1 5LB

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