Tell Us About You

What is your marital status?
---Never MarriedDivorcedWidowedSeparated

Are you new to the area?
---YesNo

What is your highest level of education?
---High SchoolSome CollegeCollege GraduateMaster’s DegreePh. D

What’s your current occupation?

How old are you ?

Your Income:
---Under $15,000$15,000 to $25,000$25,000 to $35,000$35,000 to $50,000$50,000+

What are your relationship goals?
---Casual DatingLong-term RelationshipMarriage

How long have you considered finding an alternative way of meeting people?

How did you hear about us?
---Online RadioTri 102.5K9999.9 The Point97.9 Big CountryFacebookCable TVNewspaperEventInternetDirect MailFriendOther

What encouraged you to complete this questionnaire?

I prefer to date people from the age of
to or
 It doesn't matter

I would date someone with children
---YesNo

I prefer to meet someone who has…
---High SchoolSome CollegeCollege GraduateMaster’s DegreePh. D

I would date someone who smokes
---YesNoIt Doesn’t Matter

I wish someone shared my interest in…

Things that attract me to someone of the opposite sex are

First Name:

Last Name:

Gender:

 Male Female

Home telephone:

Cell telephone:

Address:

City:

State:

Zip:

Email Address:

Typical Work Hours:

What is the best time to reach you?