Intros.org

Registration Form

+++ This information is for our administrations only and will never be given to any third party. If there is any question which you consider to be too intrusive just leave it out  +++
    
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would like to take advantage of your non-committal, free of charge offer to register with intros.org and to be informed of possible introductions that fit my criteria. I am particularly interested in meeting 

     for  Click all appropriate.
E Mails Phone Conversations Lunch Dates Theatre
Cinema Travel Sports maybe more

who live within     Miles of my home 
First Name   Surname
Address
Postcode
Telephone:  

Home
          

Work
Discretion Needed  Yes    No 
E-Mail Address
Sex:  Male:   Female:  Height:  Ft inch
Weight: Kgs or Stones Date of Birth:
Would you like to include a partner ?? Yes    No  If so Partner's First Name
Partner's Surname
Occupation:  Partner's Occupation  
Children:
Marital Status: Single:  Widow/Widower: 
Separated:  Divorced: 
Married:
Physical Type: Slim: Average:
Well Built: Heavily Built:
Smoking: Often: Occasionally:
Never:
Drinking: Often: Occasionally:
Never:
Education: None: GCSE/Equiv:
Technical: A Level/Equiv:
University: Other Degree
School: Private: Grammar:
Comp: Sec. Modern:
Other:
Religion: C of E: Protestant:
Catholic: Jewish:
Islamic: Atheist:
Other: None:
Politics: Left: Centre:
Right: No Interest:

Indicate how much you enjoy the activities below on a scale of 1 to 5. e.g. 
dislike intensely 1, dislike 2, OK   3, Interested 4, very interested  5 
Music: Classical Opera
Pop: Jazz:
Folk: Country:
Rock:
At Home: Listening to Music Reading
Watching TV Gardening
Watching Sport Cooking/
Entertaining
Being With Children Animals
Listening to Radio DIY/Crafts
Going Out: Theatre Concerts
Opera Ballet
Cinema Dancing
Parties Restaurants
Pubs Clubs/Discos
Dinner Parties Wine Bars
Outside Photography Walking/ Rambling
Green Issues Sightseeing
Motoring Foreign Travel
Sport Socialising
Keep Fit The Arts
Any other information you feel may be of help to us:-
Your attitudes reflect your personality, background and lifestyle. Consider these questions carefully and tick accordingly, Box 1 for a strong NO, 2 for No, 3 for OK, 4 for like,
 or box 5 if you like it a lot 
Your Social Life
Do you like to spend your leisure time out with other people?
On the whole do you prefer an evening at home?
Do you find it easy to approach and talk to strangers?
Do you prefer an evening out to be a casual occasion?
Would you rather go to the cinema than out for a walk?
Would you prefer living in a town to the country?
Do you have many friends of your own sex?
Do you enjoy reading a serious Sunday Newspaper?
Do you enjoy reading a popular Daily Newspaper?
Are you interested in Politics and Current Affairs?
Do you get involved in community activities?
Do you prefer team activities or sports to individual activities?
Do you feel resentful when forced to act quickly?
Indicate how well the characteristics below describe you on a scale of 1 to 5.
e.g., Box 1 for a strong NO, 2 for No, 3 for OK, 4 for Yes, or box 5 for strong Yes
Your Personality
Demonstrative Confident
Affectionate Tolerant
Moody Impulsive
Romantic Intellectual
Sentimental Adventurous
Patient Adaptable
Friendly Reliable
Considerate Fashion Conscious
Shy Practical
Cautious Ambitious
Sensitive Generous
Conventional Dominant
Serious Positive
Lively
To ensure our equal opportunities scheme is being adhered to please tick the ethnic origin which best suits your skin colouring:
European Southern European/Latin
Middle Eastern Chinese/Japanese/Far Eastern
Indian/ Pakistani Afro/ Caribbean
Mixed Race
Date of your Application