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Emmy’s Boyfriend Application

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* 1. What’s your name? (First & Last)

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* 2. What is your age? And when is your birthday?

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* 3. What is your height in feet and inches?

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* 4. What city & state do you currently live in?

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* 5. Do you have kids? If yes, how many?

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* 6. Rate your love languages 1-5:
Words of Affirmation
Quality Time
Physical Touch
Receiving Gifts
Acts of Service

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* 7. Where you taking me on our first date? And who’s paying?

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* 8. What type of relationship are you looking for?

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* 9. Contact info (email and phone number)

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* 10. By agreeing to this survey, you are allowing me to search using your name and contact info all social media accounts and do my own research on you.

Please select Yes or No.

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