Who Is Right Choice Dating
What To Expect
Success Stories
Social Events & Travel
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    Fields marked with an (*) are required !    
   
*Name:
Birthdate:
Address:
*E-mail:
*Home Phone:
Work Phone: 
Marital Status:
Single Divorced Widowed
Children:
Yes No
   Smoker Non-Smoker
Pet Allergies:
Yes No
Occupation:
Education:
Religious Preference:

What are you looking for? Lots of dates Steady Relationship
Marriage Friendship
  Other

How often do you date?
  per week per month
  haven't dated for weeks
Desired age range:
  to years old

What five characteristics are you looking for in another person?
  1:
  2:
  3:
  4:
  5:
   
What are your five favorite activities?
  1:
  2:
  3:
  4:
  5:

I am interested in:
  Introduction Services
  Stepping out Newsletter & Lectures
  The Caribbean Cruise
  Upcoming Singles Weekends

Other Comments:
Today's Date: