SUITE 1708 (level 17), 109 PITT STREET, SYDNEY NSW 2000, AUSTRALIA
TEL: 02-92210123, or 02-92210125

Name:
Street Address:
Town / City:
Postcode:
State:
Country:
Occupation:
Email:
Home Ph: Bus Ph:
Mobile Ph: Gender:
Height: Weight:
Hair Color: Eye Color:
Age: Date of Birth:
Nationality:
Place of Birth:
Marital Status:
No. of Children:
Girls (age): Boys (age):
Do you smoke: Do you drink:
Personality:
My Hobbies and interests are:


Description of the Type of Companion I Would Like to Meet

His/her age:
His/her nationality: My preference is:
 
His/her height: Min height ft ins. Max height ft ins
His/her locality
His/her Status:
Children: Comments:
 
His/her personality:
Smoking:
Alcohol:
With interest of:
View to:
Comments:


CONDITIONS OF MEMBERSHIP
 
1. I shall not visit other members without their approval.
2. I shall accept full responsibility for my behaviour towards other members and this agency.
3. I have no objections to this agency supplying my photo and any other necessary information to members of the opposite sex.
4. Failure to abide by the above conditions will result in and immediate cancellation of membership.
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