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Astro*Carto*Graphy Level I Certification Application

City, State, Zip Code__________________________________________________
Telephone: ___________________________Fax: ____________________________
E-mail address ______________________ Website__________________________

Qualifications for Level I - Professional Astro*Carto*Grapher:
(Check all categories which apply/give details in spaces provided and on back of page):
___ Basic Astrological Training (list courses, teachers or details of self study)
___ A*C*G/C*C*G Training Seminar/s (attach copy of certificate of completion)
On _______________ (dates), I attended ___ hours of training on ____________
given by (teacher)____________________________________________________

On reverse side or a separate sheet of paper, give details of lectures at Professional Conferences or by Professional Astrological Organizations: (date, lecture title, speaker)

Personal Study (List applicable books, tapes, study guides, correspondence courses)

Send application and fee to: Karen McCauley, 675 SW 126th Ave, Beaverton, OR 97005-0708
___Enclosed is ($120 domestic/ $130 international) payment to cover A*C*G Level I testing fee. I understand that this payment entitles me to one free retest next year if I am unable to pass the current Level I examination.
___Enclosed is $70 domestic / $80 international for transcript from Sept. 1993 Jim Lewis Certification Workshop.
I hereby attest that the above noted training and experience accurately portray my qualifications for analyzing and explaining A*C*G maps.
Date: ____________ Signature:________________________________________________