1) Your Name:

2) Email Address:

3) In which area do you live?

4) How far are you willing to travel in kms?
1-5     5-10     10-15     15-20     120+

5) Would you prefer in your group:
Men     Women     Men and women     No preference

6) Would you prefer:
Singles     Married     Groups with kids     No preference

7) Which day of the week are you available (PM)?
Mon     Tues     Wed     Thurs     Fri     Sat     Sun
OR - daytime on:

8) Which age category do you prefer?
25-35     35-50     50+     any

9) List any other preferences: