Home | How It Works | Testimonials | Join | Members
         
 

Membership Application                              

 
Instructions:

All text fields in this form are required fields.  You must select a response from the drop down boxes.  Please be truthful and accurate.  Providing false or misleading answers may cause the selection results to be skewed in an unacceptable manner.

In order to maximize the efficiency of our matching engine, we have tried to provide a selection of answers for each question asked.  This avoids overly subjective answers.  The choices given to some of the questions asked are updated from time to time.  Subscribed members are asked to fill out questionnaires from time to time, allowing us to re-evaluate the responses and ensure the most up-to-date answers to some of today's most important questions.

Join now!

Someone's Waiting!

 Name(First, MI, Last):

  

Sex:

MaleFemale

Mailing Address:

  

City, State, Zipcode:

      

Home Phone:

        Cell:   

Email Address:

  

Date of Birth:

  

Birthplace(City/State):

  

SSN:

   Driver's License?   I Drive A:  

Hair & Eye Color

    
Height/Weight   Feet        Inches

Ethnicity:

  
Education Level:  
School Name: Graduated:  
Income Level:   Profession:  
Religion:  
Political Affiliation:  
Appearance:   Intelligence:    
Energy Level:  
Food Preferences: American | Chinese      | Thai           | Japanese | Vietnamese Other Asian 
Spanish   | Italian        | German      | American  | Vegetarian  Other Nation
 Greek     | English (UK)| French        | Mexican   | Other Type  Special Diet 
Sports: Acrobatics | Baseball     | Basketball   | Football  | Soccer         | Tennis   
Hockey     | Skiing        | Water Skiing| Fishing   | Swim           | Boating 
Track/Field| Sailing       | Ride Horses | Flying     | Polo            | Other    
Hobbies:  
 
 

 
   
     

| Home | How It Works | Join |Testimonials | Subscribe | Members Sign-In | Contact Us | Advertise | Terms of Use | Mission Statement | About DateChecked.com |
   

Website Copyright © 2006 DateChecked.com, Inc.