| Name (first/last) | |
| What is your gender? |
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| Who are you looking for? |
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| Telephone | |
| E-mail | |
| Confirm e-mail | |
| Birthday |
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| Time of birth (if know) | |
| Where did you born? | |
Where do you live?
1. City | |
| 2. State | |
| 3. Zip (Postal Code) | |
| 4. Country | |
| Can you come to Stamford, CT? | |
| What is your eye color? |
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| What is your hair color? |
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| Which of these best describes your body type? |
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| Which ethnicities best describe you? |
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| How tall are you? |
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| What's your current annual income? |
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| What's your level of education? |
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| What is your relationship status? |
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| Do you smoke? |
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| How often do you drink? |
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| Do you have children? |
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| How many do you have? |
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| Would you like to have more children? |
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| What do you like to do in your free time? Movies? Art museums? Baseball games? Share a few of your weekend pastimes |
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| Describe yourself |
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