Full Legal Name * First Name Last Name Age * Email * Phone * (###) ### #### Skype ID (###) ### #### Notes * Date MM DD YYYY Meeting Time Hour Minute Second AM PM Meeting up to 1 hour | $1,000 up to 2 hours | $1,500 Extended per hour | $1,000 up to 12 hours | $5,000 Travel | Inquiry Monthly | Inquiry LinkedIn or Professional Info. * Include LinkedIn or employer/company, website, position Identification: Passport/Drivers License * Send photos of both ID's to m@venusianmd.com and write confirmed in the box below Etiquette * I have read and agree with the Etiquette policies and wish to proceed. I agree with all terms and Etiquette I can’t wait for us to meet,xx Diana
