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* 1. What is your full name?

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* 2. At what Email Address would you like to be contacted?

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* 3. What is your age?

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* 4. What do you do for a living?

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* 5. What is your Marital Status?

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* 6. What is your race (ethnicity)?

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* 7. Do you smoke cigarettes?

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* 8. Do you drink alcohol?

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* 9. What type of Relationship are you seeking?

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* 10. When dating someone, what distance are you willing to travel to see them on a
regular basis?

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