Personal Profile Questionaire

Please complete the Questionaire below.
It will ONLY be used for the purpose of qualifying suitable introductions for you.
ALL of the information you give will be handled in the STRICTEST CONFIDENCE.
We DO NOT disclose details of our Members to ANY other individual or organization.



PART ONE: DETAILED INFORMATION ABOUT YOURSELF

Name:
Address:
 
State / County:
Zip / Post Code:
Country:
Tel:
Fax:
E-Mail: IS THIS CORRECT!!!!!
Age:
Birth Sign:
Nationality:
Ethnic Origin:
Religion:
Height:
Weight:
Hair Color:
Eye Color
Educational Level:
Occupation:
Marital Status: Single
  Divorced
  Separated
 
Widowed
Children:
Do You: Own your own home
  Rent your home
  Live with family
Your Desire is to: To date alot
  To have steady relationship
  To get married
Do You Drive:
 
Your Personality, please
click ALL that apply to you:
Affectionate   Serious
Considerate   Shy
Romantic   Fashionable
Practical   Conventional
Reliable   Adventurous
           
Your Interests, please click
ALL that apply to you:		 Wining and Dining   Pubs/Clubs
Sports/Keep Fit   Politics/History
Reading   Travelling
Science   Cinema
Pets/Animals   Pop/Rock Music
Jazz/Folk/Country Music   Classical Music
Theatre/Arts   Watching TV
Smoking   Astrology
Children   Homemaking
Gardening   Countryside
           
Additional Information,
please provide any other
details about YOURSELF
which you think will help us
to find your ideal mate:

 

PART TWO: ABOUT YOUR IDEAL MATE

Marital Status, please select
ALL that apply

 Single
Separated
  Divorced
  Widowed
Age Range:
From: years To: years
Height Range:
From: ft To: ft
Build, please select ALL
that apply		 Physically Fit
Medium Weight
  Heavy Set
  Doesn't Matter
Children:
Educational Level:

Mates Personality, please
click ALL that apply:
Affectionate   Serious
Considerate   Shy
Romantic   Fashionable
Practical   Conventional
Reliable   Adventurous
           
Ideal Mates Interests,
please click ALL that apply:		 Wining and Dining   Pubs/Clubs
Sports/Keep Fit   Politics/History
Reading   Traveling
Science   Cinema
Pets/Animals   Pop/Rock/Rap Music
Jazz/Folk/Country Music   Classical Music
Theatre/Arts   Watching TV
Smoking   Astrology
Children   Homemaking
Gardening   Countryside
           
Please describe any qualities
you WOULD LIKE to find
in your ideal mate:
Please describe any qualities
you WOULD NOT LIKE
to find in your ideal mate:
How did you hear about
Executive Singles El Paso?:


PART THREE: PAYMENT OPTIONS


CASH, CHECK, CREDIT CARD, PAYMENT ARRANGEMENTS ARE AVAILABLE.



BEFORE SUBMITTING PLEASE ENSURE YOUR E-MAIL ADDRESS IS CORRECT


We will contact you via email or telephone to arrange your private, NO OBLIGATION, personal interview as soon as we have reviewed your data. Thank You Again!!!





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