Select Personal Introductions -

our members join us because they are looking for a dating experience that is different – a unique level of service, commitment and support - a personal dating service that really does work. Complete our application form today absolutely free.

Unlike some agencies, we do not expect you to pay in full for membership prior to meeting with your dating consultant. It is important that you are fully informed before making the decision to join. Upon receipt of your application we will contact you directly to discuss your application and our services in more detail.

All details are treated in the strictest confidence and no information is ever passed on to any third party without your consent.

About You
Title: Mr Mrs Ms Miss			Other:
Forename:			Surname:
Nationality:			Country of Origin:
Your Appearance: Caucasian European Asian Middle Eastern Far Eastern Mixed Race Black/African Other

Accommodation
Address:
Postcode:

Accommodation Type :
Terraced	Semi Detached	Detached	Apartment
Bungalow	Flat

Do you live?
Alone	With Parents	With Children	With Friends/Lodgers

Contact Details
Tel no:			Work Tel no:
Mobile no:			Private email:

When is the best time to be contacted?
Morning	Evening
How would you like members to contact you?
Home	Mobile

Employment / Education
Your Occupation
Approx. Income	(Per Annum)
Your Eductional Level
School College University
Education Qualifications: No Educational Qualifications GCSE or Equivalent A Level or Equivalent Technical Qualifications University Degree or Equivalent Other What Languages do you speak?

Personal Statistics
Age:	under 25 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65+		Date of birth
Your height:	4ft 9in 4ft 10in 4ft 11in 5ft 5ft 1in 5ft 2in 5ft 3in 5ft 4in 5ft 5in 5ft 6in 5ft 7in 5ft 8in 5ft 9in 5ft 10in 5ft 11in 6ft 6ft 1in 6ft 2in 6ft 3in 6ft 4in 6ft 5in 6ft 6in 6ft 6in+		Your weight (Gents)
Your dress size (Ladies)	6 8 10 12 14 16 18 20 20+		Your Hair Colour:	Black Dark Brown Light Brown Blonde Auburn Red Fair Grey White Shaven Bald
Your Eye Colour:	Brown Blue Green Grey Hazel

Marital Status
Single never married	Divorced	Separated	Widowed

Do you smoke?
Moderately	Occasionally	Never	Trying to give up

Children
Do you have any Children?	Yes	No
Ages
How many live with you?

Politics / Religion

Your political Views:
Left	Centre	Right	No Strong Convictions

What is your religion?
C of E	Catholic	Methodist	Buddhist
Jewish	Hindu	Muslim	Atheist
No Strong Convictions	Other:

Are You:
Practising	Non Practising

Driving
Do you drive?
Yes-Own a car	No	Learning	Hold Licence-no car

What make of car do you drive ?

Colour
Registration no

What is your preferred travelling distance?
10-45 Mins	Up to an Hour	Northwest

Your Interests
Sailing	Scuba Diving	Swimming	Yatching	Windsurfing
Water Skiing	Snorkelling	Walking	Cycling	Hang Gliding
Flying	Rambling	Canoeing	Golf	Keep Fit
Horse Riding	Squash	Table Tennis	Badminton	Abseiling
Ice Skating	Skiing	Snowboarding	Climbing	Lacrosse
Rugby	Football	Tennis	Hockey	Athletics
Running	Netball	Basketball	Archery	Parachute Jumps
Bowling	Potholing	Polo	Bungee Jump	Archaeology
Fishing	Motor Sports	Cricket	Hunting	Volleyball
Bird Watching	Embroidery	Reading	Stamp Collecting	Gardening
DIY	Bridge	Chess	Knitting	Needlework
Backgammon	Jigsaws	Cooking	Decorating	Painting
Photography	Flower Arranging	Dinner Parties	Writing	Sculpting
Pool	Breeding Animals	Dominoes	Card Games	Vounteer Work
Darts	Snooker	Ten-Pin Bowling	Martial Arts	Astronomy
Basket Weaving	Calligraphy	Origami	Dancing	Singing
Boxing	Fencing	Radio Amateur	Jogging	Crosswords
Theme Park Rides	Wine/Beer Making	Amateur Dramatics	Collecting Antiques

Are you involved in any other activities?

Are there any new activities you would like to try?

Entertainment
What do you watch at the cinema?
Blockbuster	British	Horror	Gangster
Action	Adventure	Comedy	Thriller
Sci-fi	Romance	Art Films

How often do you visit the theatre?
Regularly	Occasionally	Rarely	Never

What type of theatre/shows do you enjoy?
Musicals	Plays	Orchestral Events	Ballet
Opera	Pantomimes	Classics	Comedy
Pop Concerts	Open Air Concerts

What are your musical tastes?
Classical	Folk	Pop/Chart	Blues
Soul	Instrumental	Jazz	Dance
Motown	Reggae	Easy Listening	Indie
Rock	60's	70's	80's
90's	Country & Western.

Do you play any musical instruments?

(Specify)

Dining

Where do you prefer to dine?
Tapas Bars	Bistros	Restaurants	Hotels
Wine Bars	Cafes	Trendy Clubs	Themed Clubs
Pubs	American Diners

What are your favourite foods?
Moroccan	Mongolian	Indian	Chinese
Mexican	Japanese	French	Italian
English	Spanish	Thai	Scandinavian
Greek	Turkish
Other
Are there any types of food you do not like?

How often do you drink alcohol?
Moderately	Occasionally	Rarely	Never
What kind of drinks do you prefer?
Beer	Wine	Spirits

Holidays / Relaxation

Name your last five holiday destinations.

What would be your ideal holiday?

What type of holiday do you prefer?
Activity	Cultural	Sightseeing	Adventure
Beach/Relaxing
Other

What type of books do you read?

What newspapers do you read?

Which magazines do you read?

Which radio stations do you listen to?

Programmes I like to watch on television:

How would you, your family and friends describe your personality?

What are your future goals and ambitions?

Who I’d like to meet: (please tick any or all)

Aged between and
Preferred marital status:
Single Never Married	Divorced	Widowed	Separated

Preferred appearance:
Caucasian/white	European	Asian	Mixed Race
Middle Eastern	Far Eastern	Black/Africa Descent

Will you meet someone with children?
Yes	No	Yes, if independent
How many children would be acceptable to you?

Will you meet a smoker?
Yes	No	Casual

Height between:
Minimum	Maximum

Preferred Build:
Slim	Average	Curvy	Stocky	Heavily Built

Education level:
School	College	University

Job level:
Skilled	Semi Professional	Managerial	Professional
Retired	Entrepreneurial	Creative & Media	Financially Independent

Describe your ideal partner:

How did you hear about Select Personal Introductions?

Declaration: I confirm that I am over eighteen years old and that the contents of this, my Application Form, are true and accurate and in no way misleading and that I have never been convicted of a serious criminal offence. I understand that if any information I have supplied is found to be false and/or misleading, Select reserves the right to cancel my membership.

I confirm

 

Head Office: Select Personal Introductions, Piccadilly House, 49 Piccadilly, Manchester, M1 2AP. VIEW MAP

The Nortwest's Largest offline Introductions Agency for Professionals

Member Login

Social: