Questionnaire
Please read and fill in all carefully and complete. The information contained in red boxes will never be published or shown to other people. They are only used internally within our V.I.P.-Service, the information in green boxes will only be published on request.
Fields marked with * must be filled in.
First name:*
Country:*
Surname:*
Region:*
Code:*
Town:*
Phone:*
Street:*
Age:
Zodiac:
Height:
Weight:
Eye color:
Natural hair color:
Marital status:
Children:
Education:
Occupation:
Drinking:
Profession:
Smoking:
Religion:
Mainly I'm ruled by
heart brain
Appearance:
solid leasurely fashionable elegant representable sporty You can choose several by pressing Ctrl
For me, eroticism is
How would other people describe you?
has no problems is a little unrealistic takes life hard is ready for any fun is alway activ likes to speak is not easely made nervous
You can choose several by pressing Ctrl
My attributes are:
natural assiduous adaptable reserved mettlesome orderly spontaneous
impatient
irresolute
generous
humorous
economical ambitious romantic unpunctual honest
accurate emancipated
outgoing nature loving impetuous tender
domestic capricious strict
correct warmhearted
independent
timid egoistic patient jealous frank
curious
faithful helpful fond of children realistic punctual anxious bombastic courageous obsequious
My interests are:
mod. music class. music literature theater travel games opera operetta musical ballet cinema politics sport passive
sport active handball tennis squash gymnastics football bowling play skittles badminton riding swimming jogging hiking dancing parties
religion esotericism astrology photography .practise music writing painting philosophy psychology collecting house garden children nature animals
relaxing art pubs eating pottering needlework handcraft cooking baking puzzles traveling camping television/video computer car
motorcycle bicycle internet computer games golf minigolf skiing singing disco home plants skating
yachting
nudism
family
other
Languages:
About my future partner:
single divorced widowed separated unimportant
Hair color:
blond red brown chestnut black unimportant
Photos
photograph 2
photograph 3
photograph 4
photograph 5
I want my
e-mail phone address published
With my signature (or sending the filled in questionnaire via internet to "A Heart For Me") I hereby declare that my personal details and my photograph(s) may be used and stored with the aim of forming a partnership.
I further declare, all details given to be truthful. I agree*
Signature:
Date: