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F R E E M E M B E R S H I P A P P L I C A T I O N |
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Answers
are REQUIRED for these items:
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My
First Name or Nickname is:
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My
"Headline" is:
(Describe yourself in a few words... for example: ("Shoulder to lean on")
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My Gender:
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I Am Seeking
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for
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and also for (optional)
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Desired Age Range:
from
to
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My Ethnic Group:
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My Religion:
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My Education:
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My Current Relationship Status is
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Do I Have Pets?
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Do I Have Children?
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Do I Want Children?
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My City:
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My Area Code (US and Canada only):
(This will help someone who lives near you to find you.) |
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My State or Province:
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My Zip Code (US only):
(This will help someone who lives near you to find you.) |
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My Country:
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HABITS
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My Smoking Preference
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My Drinking Preference
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Whose Condition:
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Answers
are optional for cancer, physical, and mental conditions
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Cancers include
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which is now
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and
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which is now
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and
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which is now
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Physical Conditions include
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which is now
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and
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which is now
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and
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which is now
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Mental Conditions include
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which is now
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and
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which is now
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and
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which is now
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Please
Note:
The following items are not permitted in any essay: Phone Numbers, Addresses,
E-mail Addresses, URL's, ICQ Numbers, AOL Instant Messenger Handles, or
any other means by which a member could contact you directly. Profanity
or derogatory items are not permitted. These items are screened for by
our system and if found will result in your profile being modified/removed
from the system.
My
Life's Work or Occupation includes: (20 words or less, please)
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