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Prices are in Canadian funds.
Membership Type*:  Non Client  (No Cost)
  General ($3,600.00)/year
  VIP ($5,000.00)/year
First Name *:  
Last Name *:  
Screen Name *:  
Email *:  
Password *:  
Address *:  
Location/Intersections (locals only):  
City *:  
State/Province *:  
Postal Code/Zip *:  
Country *:  
Home Phone :  
Cell Phone :  
Birth Date(Month/Day/Year) *:  
Sex *:  
Home :  
Referred By :  
Company Name :  
Title at Work :  
Work Phone :  
Work Type :  
Do you take any medications? :  
If yes, which meds? Please list :  
Do you have a criminal record? :  
Criminal Record :  
What High School did you attend? :  
Name of College/University? :  
Educational Background :  
Marital Status :  
If separated how long? :  
If married how long? :  
If widowed how long? :  
If divorced how long? :  
Are you civil with your Ex? :  
If divorced please describe the reason?:  
If divorced with children, do you pay child support?:  
Any long term relationships? :  
If yes? How long?:  
Fatherís Occupation?(women only):  
Tribe (men only) :  
Which Synagogue/Location (locals only):  
Parents Marital Status :  
Do you get along with your parents? :  
Where were your parents born:  
Order of birth :  
Do you get along with your siblings? :  
Are you willing to contribute financially?
(women only):
Yearly Income:  
Can you afford to support a wife and children?
( men only ):
Do you have car? :  
Do you have a drivers license? :  
Have you joined any introduction service?:  
If yes which ones?:  
Allow my photo to be shown? :  
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