The  Singles  Agency

Full  Membership  Form

Cheque Payments

To receive full membership to The Singles Agency and submit a profile of yourself
please complete the following:

Your first name:

Email address:

Tel: (Optional)

Area:

Your age:

Sex:

Occupation:

Your Height: feet inches

Build:

Hair colour

Do you smoke ?

Do you drink ?

Please indicate some of your interests...

 Theatre       Dining Out         Shopping       Arts/Crafts        Music           Clubs/Pubs        Cinema
Reading           Cooking          Walking           Concerts       Sports    Holidays abroad   Computers

Please indicate which of the following best describe yourself...

 Friendly      Considerate      Easy Going        Fun loving         Tactile            Sensitive        Patient
Creative         Outgoing         Impulsive            Honest Adventurous         Passionate         Caring

If  you  wish,  we  can  construct  your  profile  from  the  information  already given .



(Optional) Please feel free to say, in your own words, what kind of person you are.




(Optional) Please list a few qualities and/or interests that your prospective partner would have.





Your Contact Details

I would like other members to contact me by:

Telephone Number    Email  

*  Please  check  your  e-mail  address  is  correct  before  submitting . You  will  not  be  able  to  use  the  site  if  you  do  not  enter  your  correct  email .