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Membership Application
HSEIA
2018-12-08T06:01:33+00:00
Personal Details
Full Name:
Gender:
Male
Female
Date of birth:
Marital status:
Height:
Weight:
Body type:
Hair color:
Brown
Blonde
Blue
Grey
Black
Red
Eye color:
Hazel
Blue
Brown
Black
Grey
Green
What is your religion?
Where did you grow up?
About You: (Brief description about you)
Family Details
Do you have any siblings?
Yes
No
Do you have children?
Yes
No
List age & sex of children(if any)?
Contact Details
Current address:
City:
Phone:
Post code:
Email:
Fax:
Occupation Details
Educational level:
Occupation:
Current Employer:
Position:
Annual Income:
Habits & Restrictions
Do you have an alcohol and/ Drug Addiction?
Yes
No
Smoking Habit:
Yes
No
Light
Social
Drinking Habit:
Yes
No
Light
Social
Exercise habit:
Allergic to:
Any Dietary Restrictions?
Animals owned
Past Relationship
Past Relationship Comments
Expectations
Describe what you are looking for in the person you would like to meet?
Do you want to have children?
Yes
No
Would you date someone who has children?
Yes
No
Been Convicted to a crime?
Yes
No
If yes to any of the above, please explain:
Match age:
Flexibility:
Not flexible
Moderately flexible
Extremely flexible
Match want to have children?
Yes
No
Maybe, I am not sure
Match religion:
Match height:
What is more important?
Looks
Money
Match ethnicity:
All
Caucasian
African
American
Hispanic/Latino
Asian
Middle Eastern
Asian Indian
Native-American
British
Multi- Ethnic
Other
First preference:
Second preference:
How did you hear about us?
Pictures
Please attach your 2 pictures
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