Meeting Attractive Asian women for love, romance and marriage; Member Application

E Meeting Attractive Asian women for love, romance and marriage; Member Application

- 98% of all Japanese enter high school.
- 42% of males and 46% of females go on to college.
- The average annual income of a 35 year-old male is approximately US$45,000 (including taxes).

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*We want you to experience our service for three months absolutely FREE.
- Please read each question carefully. Take your time to think about yourself and fill out this form.
- Pacific Relations trusts each applicant's honesty so that all the members can meet safely.
- When Pacific Relations finds out that the information you gave is false, or misleading to other members, Lieberomance has a right to cancel your membership any time without notice.
- Pacific Realtions keeps your information confidential and will never sell your information to others.

■Contact Information

First Name:

Middle Name:

Last Name:

Birth Date:

Street Address:

City:

State:

Zip Code:

Country:

Home Phone:

Cell Phone:

E-mail:

E-mail:
(Again)

How did you find about us?

Agent Name:

■Personal Data

Nationaligy:

Ethnicity:

Height:

Body Type:

Eye Color:

Hair Color:

Education:

Marital Status:

Do you have any children?

Yes No

If "Yes", what condition?

Religion:

Job Title:

Annual Income:

Language spoken:

English Japanese Korean Chinese Spanish French German Other

Smoking Habits:

Drinking Habits:

Do you want children in future?

Yes No Undecided

Are you interested in living overseas? (Willing to move to your partner's country?)

Yes No Undecided

■My Match

Age Range:

Between: and

Education:

Marital Status:

No Preference Single (never married) Divorced Widowed

Match have a child?

Rather not does not matter

Match Minumum Annual Income

Smoking Habits:

Drinking Habits:

■Questions

Would your friends consider you an outgoing person?

Yes No

Would your friends consider you a spontaneous person?

Yes No

Do you consider yourself athletic?

Yes No

Do you like sporting events?

Yes No

Do you like to go to clubs and dancing?

Yes No

Do you like to go to the movies?

Yes No

Do you enjoy a quiet evening at home?

Yes No

Do you enjoy outdoor activities?

Yes No

Tell us about you. Your likes and dislikes, your hobbies and activities.

■Important Questions

Are you physically and mentally healthy enough to conduct a normal marriage life?

Yes No

Do you have any sexual transmitted diseases (Examples are AIDS, Herpes, etc...)?

Yes No

Within the past 5 years, have you been arrested, entered a plea of guilty or been
convicted of a misdemeanor or felony offense against criminal, civil, military law,
or been released from a prison, or detention facility, or are you now under charges
for any offense against the law?

Yes No

I have read Pacific Relations' Privacy Policy and I swear that my contact information and my personal data given to Pacific Relations are all true and I comply with Pacific Relations' Privacy Policy. I understand Pacific Relations does not and will not guarantee to find my future partner.

Read Pacific Relations Privacy Policy

I agree I disagree