Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastLayoutEmail *Gender *MaleFemaleNot ListedHeightEye ColorAgeAre you vegan/vegetarian?YesNoDo you drink?YesNoOccasionallyDo you smoke?YesNoOccasionallyAre you intimidated by a partner who is successful in their career? *NoYesFor example, a partner who is equal to your earning potential, potentially has a higher professional title than yourself (VP vs Director) or someone who earns financially more than yourself.What is your idea of a good night out?Visit to the theaterRomantic dinner for twoKaraokeDrinks and Dancing at a ClubWatching a sporting eventOtherSelect all those that apply.What age range for a partner are you most interested in? *40-4545 - 5555- 6060 - 70No PreferencePhone *Sexual Orientation *StraightBi-SexualLesbianGayWhere are you located?WeightHair ColorAstrological SignDo you have pets?YesNoWhat is your profession? *How long was your last relationship? *Less than 10 years10 years- 25 years25 years or moreWhat interests you in a partner?Good Looks & StyleLoyal, Kind & TrustworthySense of Fun and Loves LifeDynamic & SucessfulPassionate & AdventurousBad Boy/Girl AttitudeYou have.... *Been DivorcedBeen WidowedNever Been MarriedDescribe your favorite hobbies and interests:Examples might include, Bike riding, Camping, Boating, Books, etc. Describe your taste in music:Describe your taste in film and television:Describe your taste in books and podcasts:What are the most important qualities in a relationship?What are somethings you are willing to compromise for the right person?Examples might be, Height, Education, Children, Religion, etcIs there anything else your potential date should know about you?Include anything which you feel would be ideal for a potential love interest, positive or negative. For example what are some of your positive and challenging personality traits.Please attach a recent picture of yourself * Click or drag files to this area to upload. You can upload up to 2 files. Custom Captcha * = Submit
