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IT IS IMPORTANT TO ME TO FIND SOMEONE WHO IS COMPATIBLE IN THE FOLLOWING AREAS
AGE*

YES NO DOES NOT MATTER
EDUCATION LEVEL*

YES NO DOES NOT MATTER
SPIRITUAL BELIEFS*

YES NO DOES NOT MATTER
HAS CHILDREN OR WANTS CHILDREN*

IMPORTANT NOT IMPORTANT DOES NOT MATTER
APPEARANCE*
INTERESTS*
OCCUPATION AND CAREER PATH*
A LITTLE ABOUT ME
IMMEDIATE SOCIAL GOAL*
CHOOSE ALL THAT APPLY*

I HAVE IN THE PAST OR NOW MEET PEOPLE ONLINE I GENERALLY DATE PEOPLE I WORK WITH, OR MEET OTHERS THROUGH THEM I DO NOT COME IN CONTACT WITH ENOUGH PEOPLE I MEET PLENTY OF PEOPLE, BUT NO ONE I WOULD CONSIDER DATING
FIRST NAME*
LAST NAME*
TELEPHONE NUMBER*
ALTERNATIVE NUMBER
ZIP CODE*
EMAIL ADDRESS*
TYPICAL WORK WEEK*

9-5 MOSTLY SWING SHIFT OVERNIGHT MY TIME IS MY OWN EXTREMELY BUSY ERRATIC AND UNPREDICTABLE
CHECK ALL THAT APPLY. I ...*

HAVE NEVER BEEN MARRIED AM DIVORCED AM WIDOWED EMOTIONALLY STABLE AND READY TO MEET NEW PEOPLE THERE IS NO ONE OR NOTHING PREVENTING ME FROM GIVING WHAT IT TAKES TO BE SUCCESSFUL IN A RELATIONSHP
I WOULD MAKE OR FIND THE TIME FOR A RELATIONSHIP WITH THE RIGHT PERSON*

OF COURSE MOST LIKELY I CAN\'T SAY
WHAT IS THE BEST DAY & TIME FOR A TELEPHONE CONSULTATION AND INFORMATION EXCHANGE? ALLOW 20 MINUTES*
Should be Empty:

IT IS IMPORTANT TO ME TO FIND SOMEONE WHO IS COMPATIBLE IN THE FOLLOWING AREAS