the Form It is sent by e-mail

the Surname:

the Name:

the Patronymic:

Date of a birth: (day, Month, year)

Time of a birth (local): (hours, Minute)

the Birthplace:

the Theme of the reference(manipulation):

Cost Sacramental:

the Way of payment:

Briefly describe your problem. For consultation send the photo or Photo of that person on which want To affect (no more than 700 кб).

the Home address (for Transfers):

*nbsp; (Region, city (village), Street, the house, apartment)

the Postal index:

the Home telephone number, Pager:



If you could not send this form from the post service can copy the text in a notebook and send any way on mine