About You
Name: *
Street Address:
Town / City:
Postcode:
State:
Country:
Occupation:
Email: *
Home Ph:
Bus Ph:
Mobile Ph:
Gender: *
Height: cm
Weight: kg
Hair Colour:
Eye Colour:
Age:
Date of Birth:
Nationality:
Place of Birth:
Maritial Status:
No. Of Your Children:
Education:
Smoking:
Drinking:
Personality:
Income: (Optional)
Residence: (Optional)
Hobbies and Interests are:
Type of Companion I Would Like to Meet
His/her age:
Min height (ft & ins):
Max height (ft & ins):
His/her Status:
Children:
Comments:
His /Her Personality
View to:
With interest of:
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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