Items marked in red are required.
First Name:
City:
State:
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of
Columbia Florida Georgia Guam Hawaii Idaho
Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New
Mexico New
York New Hampshire New Jersey North
Dakota North Carolina Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode
Island South
Dakota South Carolina Tennessee Texas US Virgin Islands Utah Vermont Virginia Washington West Virginia Wisconsin
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of
Columbia Florida Georgia Guam Hawaii Idaho
Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New
Mexico New
York New Hampshire New Jersey North
Dakota North Carolina Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode
Island South
Dakota South Carolina Tennessee Texas US Virgin Islands Utah Vermont Virginia Washington West Virginia Wisconsin
Zip Code:
Province (international only) :
Postal Code (international only) :
Country:
Afghanistan Albania Algeria Andorra Angola Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Barbuda Belarus Belgium Belize Benin Bermuda Bhutan Bosnia-Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Chad Chile China Columbia Comoros Congo Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecaudor Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatamala Guinea Guinea-Bissau Guyana Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrghyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Morocco Namibia Nepal Netherland Antilles Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Palestine Panama Papua-NewGuinea Paraguay Peru Phillipines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts-Nevis Saint Lucia Saint Vincents & Grenadines San Marino Sao Tome & Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovak Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Trinidad & Tobago Tunisia Turkey Turkmenistan Uganda Ukraine United Arab Emirates United States United Kingdom US Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Western Samoa West Indies Yemen Yugoslavia Zambia
Afghanistan Albania Algeria Andorra Angola Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Barbuda Belarus Belgium Belize Benin Bermuda Bhutan Bosnia-Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Chad Chile China Columbia Comoros Congo Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecaudor Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatamala Guinea Guinea-Bissau Guyana Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrghyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Morocco Namibia Nepal Netherland Antilles Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Palestine Panama Papua-NewGuinea Paraguay Peru Phillipines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts-Nevis Saint Lucia Saint Vincents & Grenadines San Marino Sao Tome & Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovak Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Trinidad & Tobago Tunisia Turkey Turkmenistan Uganda Ukraine United Arab Emirates United States United Kingdom US Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Western Samoa West Indies Yemen Yugoslavia Zambia
Email:
Email addresses are required
to send you your passwords. We highly recommend using two separate
email addresses, however checking this box confirms that you want to
use the same email address for each partner:
Gender:
Female
Male
Female
Male
Age:
18 to 24
25 to 35
36 to 45
45 to 55
56 to 65
Over 65
18 to 24
25 to 35
36 to 45
45 to 55
56 to 65
Over 65
Primary Ethnic Connection:
African American
Asian
Eastern European
Hispanic
Middle-Eastern
Native Peoples
Western European
Other
African American
Asian
Eastern European
Hispanic
Middle-Eastern
Native Peoples
Western European
Other
Religion:
Agnostic
Atheist
Buddhist
Catholic
Hindu
Jewish
Mormon
Moslem
Protestant
Other
Agnostic
Atheist
Buddhist
Catholic
Hindu
Jewish
Mormon
Moslem
Protestant
Other
Nbr. of Children:
Nbr. of Children (shared with partner):
Nbr. of Pets (shared with partner):
I work primarily:
Hours worked:
0 to 20
20 to 40
40 to 50
Over 50
0 to 20
20 to 40
40 to 50
Over 50
Hours watching TV:
0 to 5
5 to 10
10 to 20
Over 20
0 to 5
5 to 10
10 to 20
Over 20
Hours spent on leisure reading:
0
1 to 5
5 to 10
Over 10
0
1 to 5
5 to 10
Over 10
Hours spent on hobbies:
0
1 to 5
5 to 10
Over 10
0
1 to 5
5 to 10
Over 10
Hours of physical activity:
0
1 to 5
5 to 10
Over 10
0
1 to 5
5 to 10
Over 10
Quality hours with partner:
0
1 to 5
5 to 10
10 to 20
Over 20
0
1 to 5
5 to 10
10 to 20
Over 20
Quality hours with children:
0
1 to 5
5 to 10
10 to 20
Over 20
0
1 to 5
5 to 10
10 to 20
Over 20
Leisure time spent on email:
0
1 to 5
5 to 10
10 to 20
Over 20
0
1 to 5
5 to 10
10 to 20
Over 20
Leisure time spent on the web:
0
1 to 5
5 to 10
10 to 20
Over 20
0
1 to 5
5 to 10
10 to 20
Over 20
Leisure time spent with friends:
0
1 to 5
5 to 10
10 to 20
Over 20
0
1 to 5
5 to 10
10 to 20
Over 20
Leisure time spent with relatives:
0
1 to 5
5 to 10
10 to 20
Over 20
0
1 to 5
5 to 10
10 to 20
Over 20
Relationship Type:
Legally Married
Commitment (but not legally binding)
Civil Union (legally binding)
Other
Nbr. of Years in this relationship:
Under 1
1 to 3
3 to 5
5 to 10
10 to 15
15 to 25
Over 25
Nbr. Past Commited Relationships:
0
1 to 3
4 to 8
Over 8
0
1 to 3
4 to 8
Over 8
Education Level:
High School
Vocational/Technical School
Associates Degree
Bachelors Degree
Masters Degree
Post-Grad or Professional
High School
Vocational/Technical School
Associates Degree
Bachelors Degree
Masters Degree
Post-Grad or Professional
Profession:
Living Area:
Place of residence:
Income Level:
$0 to $30,000
$30,000 to $60,000
$60,000 to $90,000
$90,000 to $150,000
Above $150,000
$0 to $30,000
$30,000 to $60,000
$60,000 to $90,000
$90,000 to $150,000
Above $150,000
How satisfied are you with life right now:
Very Satisfied
Satisfied
Somewhat Satisfied
Not Satisfied
Very Dissatisfied
Very Satisfied
Satisfied
Somewhat Satisfied
Not Satisfied
Very Dissatisfied
Again, thank you, we are very grateful
to you for taking a few moments to answer these questions.