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* 1. First and Last Name

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* 2. Email Address

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* 3. Phone Number

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* 4. Describe yourself

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* 5. Describe your ideal WMMN partner

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* 6. What are the two most important issues you would like to share with your WMMN partner?

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* 7. Your age?

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* 8. What is your city and state location?

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* 9. On a scale of 1-5, 1=Very Blue and 5=Very Red, how would you rate your political position?

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* 10. Is there anything else you would like to share with us to help us make the best WMMN pairing?

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