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Given Name *
Surname *
Anonymity *
Required
Birth date & time (24 hour format) *
(Please enter 12pm if the time is unknown)
MM
/
DD
/
YYYY
Time
:
What is the source and reliability of the birth time? *
Please specify if your birth time is unknown or a rough estimate, whether it is from your mums memory (and whether her memory is usually sharp or sketchy!), etc. or if like me, you got your birth time from your medical records so are sure it is as accurate as it can be.
Birth Country *
for example: England
City, Region or State *
for example: Pewsey, Wiltshire
Gender *
If other, please let me know which pronoun you prefer in the text box below.
Required
The birth details I have provided are my own *
If not then whose details are they?
Required
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