Join my Heart - Men's Registration Form

*First Name

*Last Name

*Address

*City

*County/ State

*Postal Code/ Zip Code

United Kingdom United States of America Canada Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Congo Cook Islands Costa Rica Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea, Democratic Peoples Republic of Korea, Republic of Kuwait Kyrgyzstan Lao Peoples Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Martinique Mauritania Mauritius Mexico Micronesia, Federated States Of Moldova, Republic of Monaco Mongolia Morocco Mozambique Namibia Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Romania Russian Federation Rwanda Samoa Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Somalia South Africa South Georgia Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Uganda Ukraine United Arab Emirates United States of America Uruguay Uzbekistan Vatican City State (Holy See) Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe

*Email Address

*Contact Telephone

*Date of Birth

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

*Age

18 19 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

*Height

4'4" (1 m 34 cm) 4'5" (1 m 37 cm) 4'7" (1 m 40 cm) 4'8" (1 m 43 cm) 4'9" (1 m 46 cm) 4'10" (1 m 49 cm) 4'11" (1 m 52 cm) 5'1" (1 m 55 cm) 5'2" (1 m 58 cm) 5'3" (1 m 61 cm) 5'4" (1 m 64 cm) 5'5" (1 m 67 cm) 5'6" (1 m 70 cm) 5'8" (1 m 73 cm) 5'9" (1 m 76 cm) 5'10" (1 m 79 cm) 5'11" (1 m 82 cm) 6'0" (1 m 85 cm) 6'2" (1 m 88 cm) 6'3" (1 m 91 cm) 6'4" (1 m 94 cm) 6'5" (1 m 97 cm) 6'6" (2 m 0 cm) 6'7" (2 m 3 cm) 6'9" (2 m 6 cm) 6'10" (2 m 9 cm) 6'11" (2 m 12 cm) 7'0" (2 m 15 cm) 7'1" (2 m 18 cm) 7'3" (2 m 21 cm) 7'4" (2 m 24 cm) 7'5" (2 m 27 cm) 7'6" (2 m 30 cm) 7'7" (2 m 33 cm) 7'8" (2 m 36 cm) 7'10" (2 m 39 cm) 7'11" (2 m 42 cm)

*Weight

35 kg 36 kg 37 kg 38 kg 39 kg 40 kg 41 kg 42 kg 43 kg 44 kg 45 kg 46 kg 47 kg 48 kg 49 kg 50 kg 51 kg 52 kg 53 kg 54 kg 55 kg 56 kg 57 kg 58 kg 59 kg 60 kg 61 kg 62 kg 63 kg 64 kg 65 kg 66 kg 67 kg 68 kg 69 kg 70 kg 71 kg 72 kg 73 kg 74 kg 75 kg 76 kg 77 kg 78 kg 79 kg 80 kg 81 kg 82 kg 83 kg 84 kg 85 kg 86 kg 87 kg 88 kg 89 kg 90 kg 91 kg 92 kg 93 kg 94 kg 95 kg 96 kg 97 kg 98 kg 99 kg 100 kg 101 kg 102 kg 103 kg 104 kg 105 kg 106 kg 107 kg 108 kg 109 kg 110 kg 111 kg 112 kg 113 kg 114 kg 115 kg 116 kg 117 kg 118 kg 119 kg 120 kg 121 kg 122 kg 123 kg 124 kg 125 kg 126 kg 127 kg 128 kg 129 kg 130 kg 131 kg 132 kg 133 kg 134 kg 135 kg 136 kg 137 kg 138 kg 139 kg 140 kg 141 kg 142 kg 143 kg 144 kg 145 kg 146 kg 147 kg 148 kg 149 kg 150 kg 151 kg 152 kg 153 kg 154 kg 155 kg 156 kg 157 kg 158 kg 159 kg 160 kg 161 kg 162 kg 163 kg 164 kg 165 kg 166 kg 167 kg 168 kg 169 kg 170 kg 171 kg 172 kg 173 kg 174 kg 175 kg 176 kg 177 kg 178 kg 179 kg 180 kg

*Eye Colour

Black Blue Brown Gray Green Hazel

*Hair Colour

Auburn Bald Black Blonde Brown Brunette Charcoal Chestnut Golden Gray Red Silver White

*Build/ Body Type

Slim Athletic Average Large

*Education

School College Technical College University

*Occupation

*Smoker

Yes
No

Zodiac Sign

Aquarius Aries Cancer Capricorn Gemini Leo Libra Picses Sagittarius Scorpio Taurus Virgo

*Your Marital Status

Single Divorced Widowed Married

*No. of Children

0 1 2 3 4 5

Religion

Agnostic Atheist Baptist Belief in God Buddhist Catholic Christian Eastern Orthodox Humanist Judaism Lutheran Mormon (LDS) Muslim New Age Non-believer Protestant Other

Please tick languages that you speak

English German Spanish French Italian Turkish
Russian Portuguese Chinese Japanese Other

*Words About You
Please do not include personal emails or web addresses

Your Hobbies & Interests
Please do not include personal emails or web addresses

*Describe Your Ideal Partner
Please do not include personal emails or web addresses

*Ideal Partners Minimum Age

18 19 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

*Ideal Partner Maximum Age

18 19 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

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