The Singles Agency Membership form

Just complete this form and send,along with your £39 annual fee to:

YORKSHIRE AREA HEAD OFFICE

1 WELL INGS, 

SHEPLEY,

HUDDERSFIELD,

HD8 8FG

All Cheques/Postal Orders made to ‘S. A Organisation’

Your full name:

If you'd prefer to be known to our members and site visitors by a pseudonym, please enter one here. 

Other Name

Address

Telephone

Email

Age

Sex

Occupation

Build Slim Medium Large

Do you smoke? Never Occasionally Frequently

Height

Do you drink? Never Occasionally Frequently

Hair Colour

Please circle a few of your interests..

Theatre Dining Out Shopping Arts/Crafts Music Clubs/Pubs

Gardening Reading Cooking Walking Concerts Sports

Please indicate which of the following best describe yourself..

Friendly Considerate Easy Going Fun loving Tactile Sensitive

Patient Creative Outgoing Impulsive Honest

Your Profile

( Optional:  if you wish, we can construct your profile from the information already given )

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

..the person you're looking for ( Optional )

To help us help you, please list a few qualities and/or interests that your

prospective partner would have.

To the best of my knowledge the information provided is honest and accurate.

I understand that to give false information could result in my membership being terminated immediately.I am over 18 years old.

Please tell us which, if any, of your contact details provided you would like to appear on your profile: Your box number will appear automatically.

Signed

Dated

I have included £39 (Thirty Nine Pounds) as my annual membership fee

Information supplied to the Singles Agency is accepted in good faith and will

be treated as confidential. While every effort will be made to ensure success

of your membership, we can not accept responsibility for the outcome of any

contacts made through The Singles Agency. It is the members responsibility to

inform us if they wish to suspend temporarily or permanently their membership

with us. We expect our members to be courteous in their dealings with one

another at all times. We reserve the right to terminate any membership where a

lack of courtesy has been reported and to refuse or withdraw membership from

anyone deemed unsuitable

YORKSHIRE AREA HEAD OFFICE

1 WELL INGS, 

SHEPLEY,

HUDDERSFIELD,

HD8 8FG