Name: Date of Birth:
Email Address:
Webpage Address:

Height: Weight:
Hair Color: Hair Lenght: Eye Color:

Education: Occupation:

Drinker: Yes No Occasionally
Average number of drinks per week:

Smoker: Yes No Occasionally
Average packs of cigarettes smoked per week:

Peircings: Yes No
If Yes, Where?

Virgin: Yes No
If No, How many partners? (if you need more than 3 digits, don't waste my time or yours)

Religion: Yes No
If Yes, Be more specific:

Zealot? Yes No

Hobbies:

Hang Ups:

Will you freak out after our third date? Yes No

You would describe yourself as:

Plans for the Future:

Favorite Music: (be specific)

Favorite Movie:
Favorite Book:
Favorite Foods:

Astrologial Sign:

Kind of Relationship preferred: (select one)
casual love/hate just friends parasite/host committed codependant

Do you currently have a boyfriend? Yes No
Position Desired:
Date you can start: