Ladies Application

Please provide the following contact information:

            Name 
           Title 
    Organization 
  Street address 
 Address (cont.) 
            City 
  State/Province 
 Zip/Postal code 
         Country 
      Work Phone 
      Home Phone 
             FAX 
          E-mail 
             URL 

Please identify and describe yourself:

            Name 
   Date of birth 
             Sex Male Female
          Height 
          Weight 
      Hair color BlondeBrownBlackRedGrayWhite
       Eye color BlueBrownBlackGreenGrayViolet

Select any of the following activities you enjoy:

Tennis              Golf                Riding              Convertibles      
The Beach           Movies              Shows               A Good Book       
Walking             Moonlight           Dancing             Vintage Cars      
Good Friends        Computers           Staying Up Late     Getting Up Early  
Working Hard        Hard Physical Work  Hot, Humid Days     Snow              
Changing Seasons    Life Long Friends   Camping             Mountain Climbing 
Water Sking         Snow Sking          Ice Skating         In-Line Skating   
Biking              Running             Gymnastics          

Please describe other likes and dislikes?

What are your strong points?

What are your weak points?

Describe your ideal life-long mate?

Additional Comments?

Enter your inseam in the space provided below.

Enter your measurments (example 34B/25/35) in the space provided below.

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