Ok, ladies! This is your chance to win a date with yours truly. Just answer the questions below and hit "Submit" and I will process and review your application. What are you waiting for?!? This is a once in a lifetime opportunity! =P
01. Name: First Middle Last
02. Address: City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia 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 Rhode Island South Carolinda South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
03. Phone Number:
04. E-mail Address:
05. Screenname: AIM: MSN: Yahoo!:
06. Nicknames:
07. Date of Birth: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 19
08. This makes you how old (Don't lie. I will do the math):
09. Sexual Preference: Heterosexual Bisexual Homosexual
10. Hair Color: Black Blonde Brown Gray Red White Other If Other, specify:
11. Eye Color: Blue Brown Green Hazel Other If Other, specify:
12. Teeth Color: White Other If Other, specify:
13. Ethnicity: White Black Latino Asian Native American Other If Other, specify:
14. Height: 4'3 4'4 4'5 4'6 4'7 4'8 4'9 4'10 4'11 5'0 5'1 5'2 5'3 5'4 5'5 5'6 5'7 5'8 5'9 5'10 5'11 6'0 6'1 6'2 6'3 6'4 6'5 6'6 6'7 6'8 6'9 6'10 6'11 7'0
15. Weight: lbs.
16. Shoe Size: 4 5 6 7 8 9 10 11 12 13 14 15 16
17. Dominant Hand: Right Left Ambidextrous
18. On a scale of 1 - 10, 10 being the best, how would you rate your physical appearance:
1 2 3 4 5 6 7 8 9 10
19. Religion:
20. Highest Level of Education: Elementary School High School Vocational School Associate's Degree Bachelor's Degree Graduate Degree Doctorate Degree
21. Expected Highest Level of Education: Elementary School High School Vocational School Associate's Degree Bachelor's Degree Graduate Degree Doctorate Degree
22. SAT Score:
23. Yearly Income: Less than $20,000 $20,000 - $29,999 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $69,999 $70,000 - $79,999 $80,000 - $89,999 $90,000 - $99,999 $100,000 - $149,999 $150,000 - $300,000 $300,000 - $500,000 $500,000 - $1,000,000 More than $1,000,000
24. Profession:
25. Number of Languages Known:
26. Are you a virgin: Yes No
27. Pets (list all with names):
28. Favorite Color: Black Blue Brown Gray Green Maroon Orange Pink Purple Red Tan Yellow White Other If Other, specify:
29. Favorite Band:
30. Favorite Singer:
31. Favorite Song:
32. Favorite Movie:
33. Favorite TV Show:
34. Favorite Cartoon:
35. Favorite Writing Utensil (Pen, Pencil, Crayon, Bloody Finger, etc.):
36. Favorite Sport to Watch:
37. Favorite Sport to Play:
38. Favorite Place to Shop (You know you love to shop):
39. Favorite Scent:
40. Favorite Food:
41. Favorite Drink:
42. Favorite Flower:
43. How often do you drink alcohol: Never Seldom Occasionally Often Excessively
44. Do you smoke or use tobacco: Yes No
45. Do you use any drugs: Yes No
46. How often do you exercise: Never Seldom Occasionally Often Excessively
47. If you could/sleep with any person in history, who would it be and why?
48. What is the capital of Cormyr:
49. What is the ultimate meaning of life, the universe, and everything:
50. If you were to dye your hair, what color would you dye it:
51. If you were an inanimate object, what would you be and why:
52. If you were a cartoon character, who would you be and why:
53. If you could put me under a spell, what would it be called and what would it do:
54. If you could have a night alone with me, what would it consist of:
55. If Crayola decided to make your last name into a color, what color would it be:
56. If you could change one thing about yourself, what would it be:
57. Your biggest life goal:
58. Cup Size: A B C D DD DDD
59. Biggest Turn-On:
60. Biggest Turn-Off:
61. The sweetest thing a guy has ever done for you:
62. Why you want a date with me:
63. Why I should want a date with you:
64. If one train leaves New York at 7:30 P.M. EST at 65 MPH going to Chicago, and another train leaves Chicago at 10:01 P.M. PST at 53 MPH going to New York, would you go out with me if I asked you today: Yes No
