signup - Larry Schwimmer

For any of the 6 Services – Please fill in the information below. The fee for each service: $199 per service.

After you have given me your information, you will be taken to a page where you can pay securely via PayPal or credit card.

If you’d prefer to pay by cash or check, please contact me.

Once your information and payment are both received, you will be contacted by Larry to schedule a mutually agreeable date for your personal consultation and Astro Calendar or another service you’ve chosen.

Sign Up – Step 1

Service Desired:
Please select one of the following service
Service:*
What Are Your Issues, Decisions or Goals?:
Please briefly describe any major issues you are facing; or decisions you would like to make; or goals you would like to achieve within the next 12-months. Larry will give you strategy and solutions + the best times over the next 12 months to achieve successful results.
Your Issues, Decisions or Goals:*
Customer Contact Information:
Name*
First Last
Phone:*
Best time to call:
Email:*
PLEASE TELL ME HOW YOU FOUND ME:
- Huffington Post
- Yelp
- Referral by
- GOOGLE
- YAHOO
- Other
Who referred you?
Other:
My Birth Data:
Date of your Birth:*
MM slash DD slash YYYY
Time of Your Birth:

: Hours

Minutes

AM/PM
Place of Your Birth (City/Town):*
State of Your Birth:*
Country of Your Birth:*
For Relationship Compatibility Consultations Only:
For relationship compatibility consultations only, please send the birth data of the person with whom you want to assess compatibility. (If the decision is not about a relationship with a specific person please skip this section.)
Date of Their Birth:
MM slash DD slash YYYY
Time of Their Birth:

: Hours

Minutes

AM/PM
Place of Their Birth (City/Town):
State of Their Birth:
Country of Their Birth:
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