First Name * Last Name * Email * How did you hear about us? --Select-- Facebook Google Twitter Referral Television Radio Seminar/Workshop Other Photo Allowed file-types are gif, jpg, jpeg, pjpeg, png, jfif The maximum file size limit is 20 MB Date of Birth Gender * --Select-- Man Woman Non-binary State --Select-- Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas U.S. Virgin Islands Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming City Street Address 1 Zip/Postal Code Mobile Phone # Availability --Select-- Morning 8am-10am Late Morning 10am-12pm Afternoon 12pm-3pm Late Afternoon 3pm-6pm Evening 6pm-9pm Late Evening 9pm-11pm Weekend only Anytime Extra Photo #1 Extra Photo #2 Undergraduate School Education Level --Select-- High School Some College Associates Degree Bachelor's Degree Graduate Degree PhD & Above Masters Degree Professional Qualification Diploma Advanced Diploma Polytechnic Junior College & Below A Levels & Below Major In Graduate School Graduate School Degree Received I am (An Introvert is a 0, and Extrovert is a 10) --Select-- 0 1 2 3 4 5 6 7 8 9 10 About Me (Who I am) Do you have children? --Select-- Yes - living at home full-time Yes - living at home part-time Yes - they are adults No Yes Add Children Age Describe what you are looking for in the person you want to meet Occupation Industry Ethnicity --Select-- Caucasian African-American Hispanic/Latino Asian Middle Eastern Asian Indian Native American Multi-Ethnic Other Black Chinese Pacific Islander Malay Eurasian East Indian African Religion --Select-- All Agnostic Atheist Buddhist Christian (Catholic) Christian (Protestant) Christian (Other) Hindu Muslim Jewish Pagan & Earth-Based Scientology Taoist Unitarian Universalist Spiritual, not religious Other Free Thinker LDS Hobbies Hair Color --Select-- Brown Blonde Red Blue Grey Black Mixed Auburn Salt & Pepper Bald White Other Eye Color --Select-- Brown Blue Green Hazel Black Grey Body Type --Select-- Slender Athletic Average A few extra pounds Large Petite Fit Curvy Height --Select-- Less than 5'ft (Less then 152cm) 5'ft (152-154cm) 5'1"ft (155-156cm) 5'2"ft (157-159cm) 5'3"ft (160-162cm) 5'4"ft (163-164cm) 5'5"ft (165-167cm) 5'6"ft (168-169cm) 5'7"ft (170-172cm) 5'8"ft (173-174cm) 5'9"ft (175-177cm) 5'10"ft (178-179cm) 5'11"ft (180-182cm) 6'ft (183-184cm) 6'1"ft (185-187cm) 6'2"ft (188-190cm) 6'3"ft (191-192cm) 6'4"ft (193-195cm) 6'5"ft (196-197cm) 6'6"ft (198-200cm) 6'7"ft (201-202cm) 6'8"ft (203-205cm) 6'9"ft (206-207cm) 6'10"ft (208-210cm) 6'11"ft (211-212cm) 7'ft (213cm) More than 7'ft (More then 213cm) Weight --Select-- Less than 90lb (Less than 41kg) 90-96lb (41-43kg) 97-102lb (44-46kg) 103-109lb (47-49kg) 110-115lb (50-52kg) 116-122lb (53-55kg) 123-129lb (56-58kg) 130-135lb (59-61kg) 136-142lb (62-64kg) 143-148lb (65-67kg) 149-155lb (68-70kg) 156-162lb (71-73kg) 163-168lb (74-76kg) 169-175lb (77-79kg) 176-181lb (80-82kg) 182-188lb (83-85kg) 189-195lb (86-88kg) 196-201lb (89-91kg) 202-208lb (92-94kg) 209-215lb (95-97kg) 216-221lb (98-100kg) 222-228lb (101-103kg) 229-234lb (104-106kg) 235-241lb (107-109kg) 242-248lb (110-112kg) 249-254lb (113-115kg) 255-261lb (116-118kg) More than 262lb (More than 119kg) Annual Income --Select-- Less than $50,000 $50,001 to $75,000 $75,001 to $100,000 $100,001 to $150,000 $150,001 to $200,000 $200,001 to $250,000 $100,001 to $250,000 $250,001 to $500,000 $500,001 to $1M $1M to $3M More than $3M More than $5M More than $10M More than $15M More than $20M Smoking Habits --Select-- No Light / Social Yes Drinking Habits --Select-- No Light / Social Yes Relationship Details Describe your longest relationship The most important relationship Marital Status --Select-- Divorced Separated Widowed Still Married Never Married Single It's Complicated No. of children Any serious medical conditions? --Select-- No Yes Been a patient at mental health facility? --Select-- No Yes Been convicted for crime? --Select-- No Yes If yes to any of above, please explain