Form // Essential Year Ahead -

Essential Year Ahead Astrology Report Data Submission Form

Your Daily Astrology Forecast is customized to your Birth Name and Date. Therefore, we need you to fill out the following form.

IMPORTANT – make sure to fill out your birth date with the MONTH first, followed by the DAY, then year (MM/DD/YYYY)

Name

First Last

Birth Month:(Required)

Birth Day of Month:(Required)

Please enter a number from 1 to 31.

Birth Year

Please enter a number from 1900 to 2022.

Birth Time(Required)

If you do not know your birth time, enter 12pm

Were you born in the United States or Internationally?(Required)

Yes, I was born in the United States

No, I was born somewhere Outside the United States

Birthplace City or Town

City State

Birthplace City or Town

City State / Province / Region Country