New lady registration form

First name :
Surname :
Postal code :
Address :
City :
Country :
Phone :
Mobile phone :
E-mail :
Date of birth (dd-mm-yyyy) :	- -
Height :	cm
Weight :	kg
Color of eyes :
Color of hair :
Marital status :	unmarried divorced widow
Children :	quantity: sex, age :
Education :	Primary Secondary Higher
Profession :
Knowledge of languages (please rate from 1-10):
Child wish :	Yes No Maybe
Religion :
Character description :
Character description partner :
Partner's age :
Is it a problem when the partner already has children?:	yes no

Happy Connections
Seinpostweg 4/29
2042 AB Zandvoort
The Netherlands
tel.: +31(0) 23 5262007
info@happyconnections.nl