Surname:
Forename:
Age:
Occupation:
Address:
Apt.
Number:
City:
State:
Zip (Postal)
code:
Country:
* Email
Address:
* Home
Telephone:
Work
Telephone (if applicable):
Fax:
Best
time to contact:
Nationality:
Country
of birth:
Height
(ft. & in., or cm.):
Weight
(lbs. or kgs.):
Color
of Hair:
Color
of Eyes:
Please
click any field that applies to you
Your
build:
Status:
Slim
Single
Average
Divorced
Well built
widower
Heavily built
Separated
Ethnic
Origin:
Accommodation:
European
Own
Rent
American
Middle Eastern
House
Asian
Appartment
Indian
Room
Do you
smoke?:
Do you
drink?:
Occasionally
Occasionally
Moderately
Socially
Heavily
Regularly
Never
Never
Education:
Religion:
Secondary School
Roman Catholic
Comprehensive School
Protestant
Preparatory School
Jewish
Public School
Islamic
College
Buddhist
Polytechnic
Hindu
University
Agnostic
Other
No Religion
Select
any of the following adjectives that might
apply to you:
Affectionate
Adventurous
Considerate
Gregarious
Sensitive
Shy
Romantic
Reserved
Humorous
Cautious
Moody
Serious
Extrovert
Creative
Confident
Intellectual
Self Assured
Dependable
Strong willed
Tolerant
Dominant
Predictable
Ambitious
Practical
Other
Evening
Entertainment:
Ballet
Night Clubs
Cinema
Parties
Concerts
Pubs
Dinner Parties
Theatre
Opera
Wine Bars
Musicals
Restaurants
Other
Sports
and Outdoor Activities:
Badminton
Rugby
Cycling
Sailing
Fishing
Shooting
Flying
Sking
Soccer
Squash
Football
Sub Aqua
Golf
Swimming
Basketball
Tennis
Keeping fit
Walking & Hiking
Riding
Softball
Other
Select
if you are interested in any of the following
activities:
Reading Novels
D.I.Y.
Newspapers/Magazines
Painting
Television-Soaps
Photography
Television-News
Gardening
Television-Films
Cards
Volunteer work
Chess
Collecting stamps
Cooking
Please describe your ideal partner
Build:
Hair
color:
Slim
Blonde
Average
Brown
Well built
Brunette
Heavily built
Red head
No preference
No preference
Age:
Height
(ft. & in., or cm.):
Min
Min
Max
Max
Complexion:
Partners Status:
Very Fair
Single
Fair
Divorced
Medium
Separated
Dark
Widower
No preference
No preference
Please
answer yes or no to the following questions:
Do
you mind if your partner has children?
Do
you mind if your partner smokes?
Do
you mind if your partner drinks?
Partner's religion (select acceptable religions):
Roman Catholic
Buddhist
Protestant
Hindu
Jewish
Christian
Islamic
No preference
Partner's musical tastes:
Opera
Pop
Classical
Oriental
Country
Rock 'n' Roll
Jazz
No preference
Folk