First
Name:
Last Name:
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Your Membership Name / Nick
Name
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Your Email Address
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What country were you born in?
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What country are you calling
from?
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What city or town do you live in?
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Suburb:
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Post code:
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ICQ Number :
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Sex:
|
Marital Status:-
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Birthday:
19
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Age:
.
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Description of Yourself
|
Colour of
my Eyes
|
Colour of
my Hair
|
My Hair
Length
|
Do you wear
Glasses?
|
Are you a
Smoker?
|
My Weight
|
Do I Drink
to get drunk?
|
Do you have
any of your Body Pierced?
|
Do You Have
any Tattoo's?
|
.
|
My Height
|
.
|
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Other Things
not listed
.
|
Description
of Ideal Partner
.
|
List of
things you like to do / Hobbies and
interests:
.
|
List of
ideas you might have of places you might like to go and outings you might like to have:
.
|
Your Site URL ( Do you have a web
page? )
.
|
Do you want your ICQ No. and Email address displayed on the Members List?
|
How did you find us?
.
|
Do you plan to visit this Site
again in the future?
Yes No Maybe
.
|
Simple Feedback About this
site
|
OR
All
Comments welcome.
|
|
