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Personal Profile Submission Form

This form is for submitting your data for sending your data to 372 local dating agencies in Russia, Ukraine, Belarus and Kazakhstan.

After you fill out the form, you will be taken to the confirmation page. 

  

 

 

  
Full Name*
  You can use pseudonym if desired
Address*
Country*
Phone
FAX
E-mail*
 
Your age*
Height*
Weight*
Hair color
Eye color
Race
 
 
Marital status*:  single
 divorced
 widower
 married
 
Do you have children?  no     yes

If yes, please specify gender and age.
 

Education* (you can choose several options):
 
school
special
college
university
postgraduate
Languages Speaking*
(please mark if you can communicate in the language at least on basic level):
 
English
German
French
Italian
Russian
Other:
 
Occupation*:

Interests and hobbies* (max 200 characters):
 

Personality* (max 200 characters):
 

Religion*:
Smoking* no
sometimes
yes
Drinking*  no
 socially
 sometimes
 often
 
Requirements to a partner
(If parameter is not important for you, leave the windows blank.)
 
Age: from to
Height: from to
Build: doesn't matter  slim  average plump
Kids OK? OK maximum 1 no kids
Other requirements (woman's personality, interests, education etc)
 
 
 
 
 
 
 
 

 

 

 

Your Message* (maximum 1000 characters):
 

Check the information before submitting, particularly your addresses. Please press the button only ONCE, it may take up to 1 minute to process the query and receive confirmation.
 

 

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