Hello! Thank you for taking the time to fill out this questionnaire! I am conducting this survey to help determine the accuracy of Numerological divination. In other words, I am determining whether or not Numerology is a crock. Results, once published, will be sent to you if you would like.
Section One: Personal Data
Name at Birth: ___________________________
Date of Birth: ____________________
name you introduce yourself as : ___________________________
(Hi, I'm Bob Smith)
Section Two: Ideals & Characteristics
Please Check the characteristics that mean the most to you:
- ___Self-Confidence, Leadership
- ___Balance, Diplomacy, Peace
- ___Self-Expression, friends, parties
- ___Hard Work, Loyalty
- ___Freedom, Variety
- ___Love, Family, Nurturing, Helping Others (friends&family)
- ___Thought, Wisdom, Time Alone
- ___Power, Money & Success
- ___Wisdom, Altruism, Helping Others (worldwide)
Now Please circle your favorite numbers:
Do you have any other favorite number(s)?
Please put it or them right here: __________________________
Do you want to find out about the results of this survey? ___Yes ___No
Thanks!