Registration Form
YOUR DETAILS
Name:
DOB:
Place of Birth :
Home Address:
Postcode:
Phone (home):
Phone (mobile):
Phone (fax):
Email:
Any other contact details:
Drivers license number:
Medicare number:
Education level:
Occupation:
Hours Worked:
Details if you work away:
Marital status:
Family Responsibilities (Children etc) :
Are you interested in having children:
Age:
Height:
Weight:
Hair Colour:
Eye Colour:
Do you smoke:
Do you drink alcohol:
Nationality:
Fathers nationality:
Mothers nationality:
How long in Australia:
Languages spoken:
Religion:
Regular church attendance:
Are you currently living with:
Are you:
Renting
Buying - in a -
House
Unit
Would you move if you found the right person:
if so how far would you move:
Spare time interests/hobbies:
How would you describe yourself (Personally, like, dislikes etc) :
Do you have transport:
Yes
No
Type:
Do you have pets:
Yes
No
Type:
IDEAL MATCH DETAILS
Age range preferred:
From
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
to
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
preferred age
Preferred area:
Will person outside above areas willing to travel be ok:
N/A
Yes
No
Any preferred nationality/nation of origin:
Preference regarding smoking :
Preference regarding drinking:
Physical preferences:
Any preferences in person's education:
Occupation:
Marital Status:
Children:
Yes
No
if yes how many
Religion:
Accommodation:
Transport:
Describe your ideal match:
Any particular attributes you consider important your match should have:
What is important to you in forming a relationship:
Type of relationship you are looking for (please tick more than one if applicable):
Casual
Friendship
Relationship
20-30 Connect
Country Love
Christian Hearts
please
describe
Please add any other particulars you feel we should know about:
Any required alias for advertisements:
I authorise my photo for for publication:
Yes
No
Please indicate the best time for us to contact you:
After submitting the Registration Form please forward a picture of yourself to thelovedetective@bigpond.com .
MEMBERSHIP DETAILS
Please select your membership:
(includes GST)
Membership entitles the member to unlimited amount of quality contacts on either 3mths/ 6mths/12mths membership.
PAYMENT DETAILS
Please select payment method
Credit Card
Cheque
Money Order
Please send cheque or money orders to PO Box 1069 Joondalup Business Centre 6919
Card Type:
Visa
Mastercard
Bankcard
Card Number:
Expiry Month:
January
February
March
April
May
June
July
August
September
October
November
December
Expiry year:
2007
2008
2009
2010
2011
2012
2013
Name on Card:
CVC number (3 digit number on back of card)
