First Name:

*

Last Name:

*

Email:

*

Day Phone: *

Please include area code

Evening Phone: *

Please include area code

Birthday:

* (00/00/0000) Confidential

Time of Birth:

 Please include, if you know the time of your birth

Place of Birth:

 Please include (City, State or Country - if known)

Gender:

Please choose one below: Male Female

Height:

 Please include feet and inches

Education Level:

Please choose one below: High School Some College Trade/Technical Associates Degree 4-Year College/University Masters Degree Doctorate Degree Other (See Below)

Other Education:

(If not on list)

Age-Range Preferred:

* Enter Range (i.e. 35-45)

Marital Status:

Please choose one below: Never Married Legally Divorced Widowed Separated

Current Family Status:

Please choose one below: Have Children Living at Home Have Children/Share Custody Have Children/They Don't Live at Home Don't Have Children

Desired Family Status:

Please choose all that apply:
Desire to Have my Own Children Am Open to Adoption Do Not Desire to Have my Own Children Am Open to Having Children Have no Preference

Marriage Attitude:

Please choose one below: Would Like to Get Married Open to Marriage Unsure About Marriage Don't Want to Marry

Ethnicity:

Please choose one below: Asian Black / African Descent East Indian Latino / Hispanic Middle Eastern Native American Pacific Islander White Caucasian Other

Your Smoking Style:

Please choose one below: Non-Smoker Smoker Occasional Smoker Occasional Cigars

Your Drinking Style:

Please choose one below: Non-Drinker Drink 0-3 Times/Month Drink 1-3 Times/Week Drink 3-5 Times/Week Drink 5+ Times/Week

Your Exercise Style:

Please choose one below: Do Not Exercise Exercise 1-3 Times/Week Exercise 3-5 Times/Week Exercise 5+ Times/Week

Your Eating Style:

Please choose all that apply:
VeganVegetarianEat Fish &/or Chicken Eat Red MeatRaw Foodist
Other (See Below)

Other Eating Style:

(If not on list)

Preferred Cuisines:

Please choose all that apply:
AmericanCajunChineseEast IndianFast Food
FrenchGermanGreekHealth FoodItalianJapanese MexicanMiddle EasternRussianSeafoodThaiVietnameseOther (See Below)

Other Cuisines:

(If not on list)

Your Spiritual Focus:

Please choose all that apply:
AgnosticAtheistBuddhist/Taoist Catholic Christian (Born Again)
Christian BasedHinduIslamicJewishLutheranMethodist Presbyterian ProtestantReligious ScienceSpiritual - Not ReligiousUnityOther (See Below)

Other Spiritual Focus:

(If not on list)

Current Spiritual Focus:

Please choose one below: Active Inactive Active - Do Not Attend Services

Physical Activity Involved In:

Please choose all that apply:
AerobicsBack PackingBallroom DancingBaseball/Softball
Basketball BikingBowlingDancingGolfGymHang GlidingHiking JoggingMartial ArtsRacquetballRiver RaftingRock Climbing RollerbladingSailingSnorkelingSnow SkiingSoccerSurfing/WindsurfingSwimmingTennisVolleyballWalking
Water SkiingWeightsYogaOther (See Below)

Other Physical Activity:

(If not on list)

Hobbies/Interests:

Please choose all that apply:
ArtCarsComputersCookingDining OutFishingGardeningHealthHuntingInvestingMoviesMusic OutdoorsPersonal Growth PhotographyReadingSculptureSpectator SportsTelevisionTheatreTravelWood WorkingWritingOther Hobbies(See Below)

Other Hobbies/Interests:

(If not on list)

Musical Preferences:

Please choose all that apply:
AlternativeBig BandClassicalContemporaryCountry
FolkHard RockHip HopJazzLatinNew AgeOldies OperaPopR&BRapReggaeRock & RollSoft RockOther (See Below)

Other Musical Preferences:

(If not on list)

Pets I Have:

Please choose all pets that you currently have:
BirdsCatsDogsExotic PetsFish
Gerbils / Guinea Pigs / Etc.HorsesReptilesOther (See Below)

Other Pets:

(If not on list)

Pets I Would Like:

Please choose all pets that you would be happy to have, if your partner wanted them:
BirdsCatsDogsExotic PetsFish
Gerbils / Guinea Pigs / Etc.HorsesReptilesOther (See Below)

Other Pets I Would Like:

(If not on list)

Pets that cause allergic reaction:

 (If any)

Affection Level in Public:

On a scale from 1-10 with “10” being extremely affectionate and “0” being not affectionate at all, how affectionate are you in PUBLIC?
Please choose one below Extremely Affectionate - 10 Affectionate Level - 9 Affectionate Level - 8 Affectionate Level - 7 Affectionate Level - 6 Affectionate Level - 5 Affectionate Level - 4 Affectionate Level - 3 Affectionate Level - 2 Not Very Affectionate - 1 Not Affectionate - 0

Affection Level in Private:

On a scale from 1-10 with “10” being extremely affectionate and “0” being not affectionate at all, how affectionate are you in PRIVATE?
Please choose one below Extremely Affectionate - 10 Affectionate Level - 9 Affectionate Level - 8 Affectionate Level - 7 Affectionate Level - 6 Affectionate Level - 5 Affectionate Level - 4 Affectionate Level - 3 Affectionate Level - 2 Not Very Affectionate - 1 Not Affectionate - 0

I prefer to date people from the following ethnic groups:

Please choose all that apply:
Asian Black / African Descent East Indian Latino / Hispanic Middle Eastern Native American Pacific Islander White / Caucasian Have no Preference

Importance of Financial Success:

Importance whether mate is Financially Successful
Please choose one below Very Important Somewhat Important Neutral Somewhat Unimportant Very Unimportant

Importance of Physical Attractiveness:

Importance whether mate is Physically Attractive
Please choose one below Very Important Somewhat Important Neutral Somewhat Unimportant Very Unimportant

Importance of Similar Affection Level:

Importance that mate has Similar Affection Level
Please choose one below Very Important Somewhat Important Neutral Somewhat Unimportant Very Unimportant

Importance of Similar Education Level:

Importance that mate has Similar Education Level
Please choose one below Very Important Somewhat Important Neutral Somewhat Unimportant Very Unimportant

Importance of Similar Health Focus:

Importance that mate has Similar Health Focus
Please choose one below Very Important Somewhat Important Neutral Somewhat Unimportant Very Unimportant

Importance of Similar Intelligence:

Importance that mate has Similar Intelligence
Please choose one below Very Important Somewhat Important Neutral Somewhat Unimportant Very Unimportant

Importance of Similar Spiritual Focus:

Importance that mate has Similar Spiritual Focus
Please choose one below Very Important Somewhat Important Neutral Somewhat Unimportant Very Unimportant

Non-Negotiables:

What are your Non-Negotiables when considering someone as a partner?

Physical features preferred:

What physical features do you prefer when choosing a partner?

Event Locations:

Please choose one answer below:
Within 0-10 miles of my zip code Within 0-20 miles of my zipcode
Within 0-30 miles of my zip code Within 0-40 miles of my zip code
Within 0-50 miles of my zip code Within 0-60 miles of my zip code
Within 0-70 miles of my zip code No Preference

My Home Zipcode:

*

Singles Events:*

Are you interested in receiving notifications of fun, interactive Singles Events?
Please choose one below Yes No

Dating Tips:*

Are you interested in receiving emails with informative Dating Tips?
Please choose one below Yes No

Tips on Manifesting:*

Are you interested in receiving emails with Tips on Manifesting?
Please choose one below Yes No

Comments or Feedback

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Contact Information:

First Name:*

Last Name:*

Daytime Phone:

Evening Phone: *

Email:*

Private Singles Events:

Dinner Availability:

2. Have you completed a Private Profile?

Please choose one below Yes No

2a. If you have not completed a Private Profile, what date can we expect to receive it?

3. Do you want to submit your own photo or have a photo taken?

Please choose one below Submit own photo Have a photo taken

4. Have you submitted a photo?

Please choose one below Yes No

4a. If you have not submitted a photo, what date can we expect to receive it?

Comments or Feedback

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