Good Genes Member Application

This information will be used only by Good Genes and will not be made
available to any other group or used for any other purpose. It is our policy
to refund all or part of the membership fee if the member is discontented.
We reserve the right to suspend or terminate any membership at any time.
  First Middle Last  
Name:  
Gender: Male: Female:
Daytime Phone: Evening Phone:
Cellular Phone: Fax:
Email Address:
Billing Address
Administrative Use This address will only be used by Good Genes. It will not be revealed to other members.
Line One:
Line Two:
City:
US State: NON-US State/Province:
Zip/Postal Code:
Country:
Biography
Please fill in the information as you would like it to appear in your biography.
  First Middle Last  
Name:
Method of Contact
If you choose Email as your preferred method of contact, please pick a second method as well.
  1  2   
  3  4   
  5  6   
 
Address
For Display This address will be revealed to other members when they request your biography. Only enter as much as you wish them to be able to see.
Line One:
Line Two:
City:
US State: NON-US State/Province:
Zip/Postal Code:
Country:
Personal Information
Short Profile:
(35 words minimum; age and schools required; religion optional)
Desired Web Site Password:
Education & Occupation
Occupation:
School Number 1
Please Select A School:
Unlisted school:
Degree or Faculty Status:
Year of graduation or employment:
School Number 2
Please Select A School:
Unlisted school:
Degree or Faculty Status:
Year of graduation or employment:
School Number 3
Please Select A School:
Unlisted school:
Degree or Faculty Status:
Year of graduation or employment:
Vital Information
Age:
Marital Status:
Height: Feet:   Inches:
Weight:
Number of Children:
Ages of Children:
Religion:
Religion Details:
Do you value having a companion who shares your beliefs? Yes:     No:     Does not matter:
You may expand upon this if you wish.
Are you willing to provide a photograph of yourself?
Yes:     No:     Optional:
Questions
Physical Description (other than height and weight):
What is your preferred reading material (books/magazines/newspapers):
Particular interests and hobbies:
Which interests are important for your companion to share?
Personal thoughts on politics (your social views):
Your description of a good relationship:
Type of vacations you prefer:
Describe the traits of your ideal companion:
How do you spend your leisure time?
What aspects of your personality are the most important that you have to contribute to a relationship?
Is there anymore interesting and/or important information about yourself that you wish to add to your biography? (Personal thoughts on relocation &/or long-distance relationships may be added here)
How did you hear about Good Genes?
  Details:
Where else could Good Genes advertise? How could Good Genes better serve your needs?
   
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