Please tell me your name:                                 (Do not hit return)

State of living:                                                   (Do not hit return)

City:                                                                 (Do not hit return)

Job or studies:                                                  (Do not hit return)

E-Mail Address:                                               (Do not hit return)

If You have no E-Mail, enter your "Snail Mail": (Do not hit return)

Main interests:                                                  (Do not hit return)

How do you see the main values of family life?

How old are you?

Under 18 years old
Between 19 and 24 years old
Between 25 and 32 years old
More than 32 years old

Height:

Under 148 cm
From 148 to 154 cm
From 155 to 164 cm
From 165 to 174 cm
175 cm and more

Weight:                                                 kg (Do not hit return)

Body Type:

Slim
More Average, than slim
Average
More fat, than average
Fat

Hair:

Short
Medium
Long

Hair Color: Choose One Blonde Black Red Brunette

Eye Color:  (Do not hit return)

Skin Color: (Do not hit return)

Your religion:  (Do not hit return)

Ethnic Origin of Your Father: (Do not hit return)

Ethnic Origin of Your Mother: (Do not hit return)

Total Number of brothers & sisters: (Do not hit return)

Please describe your face and body

Please describe your favorites and abilities:

Please give any additional info to complete Your image:

Have you been married before?

Yes
No

Are You ready to send me Your photo?

Yes
No
I shall decide

How much children do You have now? (Do not hit return)

How much children do You plan in Your family? (Do not hit return)

Do You smoke? Choose One No Occasionally Yes

Do You drink? Choose One No Occasionally Yes

Do You take drugs? Choose One No Occasionally Yes

Thank You for this hard work.