Jill Leigh STUDENT CONSULTATION PAYMENT FORM Student Consultation Payment Form Please pay for your session by completing the form below. If you are human, leave this field blank. Name First Last Last Email Choose Your Session 200 — Sixty Minutes 300 — Ninety Minutes Credit Card Credit Card Credit Card Credit Card 1 2 3 4 5 6 7 8 9 10 11 12 Credit Card 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 Credit Card
