Your Legal First Name :

Your Legal Last Name :  

            Gender:           Male Female

Street Address :

City: State : Zip :

Country:

Phone Number:     
                        Home Office  Cell

Email Address:

Confirm Email Address :

Do you have a Business Website:  YES NO

Website URL: 
                     (http://yourwebsitename.com)

How long have you have your website
on-line? 

What Name do you use for your professional business:
      
     (i.e.; High Priestess Astor, Athena, etc)

Do you speak English?   YES NO

If not, what is your primary language? 

Please check all the boxes below that are pertinent to your services:

Website
In person consultations
Phone Consultations
Email Readings
 Email Spell-casting services
 Prepared Readings
 All of the Above
Other

If Other, please provide additional information here:

THIS SECTION TELLS US MORE ABOUT YOUR SPECIALTIES:

How long have you been professionally offering your psychic services:

How long have you been offering your psychic services on-line?



Please check the specialities below that pertain to you. If the activity is not listed, please provide details in the 'Other' section.

Psychic Readings - General
Love Psychic
 Past Lives
 Medium
 Tarot Cards
 Astrology/Horoscopes
 Spell-casting
 Animal Psychic
 Psychic Detective
 Voodoo
 Dream Interpretation
 Channeling
 Healing - General
 Reiki
 Work with Guides
 Email Readings
 Other

If Other, please provide additional information here:

Do you offer your services through any on-line psychic networks (i.e.; Keen, etc)

YES NO

If Yes, which one(s)


Have you ever been certified as a psychic?  YES NO

ELIGIBILITY

Please tell us in your own words all you, your philosophy, how you developed or discovered your special talents, etc? 


Please tell us about your practice. 




YOUR INFORMATION

Please let us know what information we can list in our PSYCHIC DIRECTORY.  You can chose any or all of the following. 

Your First Name
Your First & Last Name
The Name you use in Business (i.e.; Athena, Diana, Astara, etc)
Your City/State
Your Email Address
Your Website
All of the above
NONE
Other

If Other, please describe



PRIVACY STATEMENT

Please review our privacy statement before submitting this Certification Application. The privacy statement can be viewed on the 'Privacy' page of this website or by clicking on the privacy statement link below.

I have read and agree to your privacy statement .

YES NO


CODE OF ETHICS & CONFIDENTIALITY AGREEMENT

Please carefully review the International Certification of Psychics Code of Ethics & Confidentiality Agreement.  By typing your name below you are electronically signing to confirm that you have read and reviewed the Code of Ethics and that you agree to abide by them at all times.  Upon acceptance into the International Certification of Psychics we will send you a hard-copy to sign.

I have read and agree to your Psychic Code of Ethics  & Confidentiality Agreement.

YES NO

Have you ever offered your psychic abilities as a reader/counselor using another other name or business name?

YES NO
If Yes, what other name(s)


SECURITY QUESTIONS

In order for you to make any future changes to this profile - please answer these 3 security questions.  In the future, you will need to provide us with your answers to make any changes.

1.  Your mother's middle name:
    

2.  High School you attended:
    

3.  Last 5 digits of your  cell phone number:
                   

RELEASES:

I give my permission to The International Certification of Psychics to use the personal information I have indicated above in their publications and/or on-line database for the sole purpose of identifying my services as described above. 

YES NO

I also give my permission to the International Certification of Psychics  to use any pictures I provide to them on their on-line database and/or in their publications.

YES NO

By checking these boxes and typing my name below I give my permission for my profile to appear on Psychic Directory database, in advertisements, in publications and advertising and/or marketing avenues the International Certification of Psychics  deems necessary.  I agree to these terms for a period of no less than ten years (10 years).

YES NO

I agree to the above terms and I am printing my legal name below which will serve as an electronic signature.




Please note:  You may be asked to sign a separate Release agreement.


PROMOTION/DISCOUNT CODE:  


Please note:  You may be asked to sign a separate Release agreement.

IMPORTANT:   Please let us know how you heard about the International Certification of Psychics .






Thank you for completing this form.