Private Video Message
Please fill in the information below to receive a personal intuitive life coaching video message from me!  
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Email *
Your Birthday *
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Your Name *
QUESTION 1 (+ brief details explaining question if necessary) - please include the date of birth (or sign) of anyone involved in the situation. *
QUESTION 2 (+ brief details explaining question if necessary) - please include the date of birth (or sign) of anyone involved in the situation. *
QUESTION 3 (+ brief details explaining question if necessary) - please include the date of birth (or sign) of anyone involved in the situation. *
QUESTION 4 *optional* (+ brief details explaining question if necessary) - please include the date of birth (or sign) of anyone involved in the situation.
Please note - *as it states on my website, there are no refunds on any life coaching session / intuitive messages. Please be sure you desire a message before purchasing* *
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You understand this private video message will be returned to you via email within 4 days of receiving request form & payment. *
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Please select one of the links below to complete payment, then submit this request form. [Up to 20 minute PRIVATE VIDEO MESSAGE $55.55] *PLEASE PUT YOUR EMAIL IN PAYMENT NOTES SECTION*  .      .      .     .     .      .      .    (this will open a new webpage, please press the back button or open this page again to submit this form. thanks!) *
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