Life's A Birch, Then you Die

Girlfriend Application

Contact Questions

Name:
Nick Name:
Email Address:
Phone Number:

Numeric Questions

Height:	ft in m
How Many Children Do You Have?
Your Birthday

Questions I Have No Right To Ask, But I'm Asking

Occupation
Education Level
Do You Smoke?	Yes No Occasionally Just Pot
Do You Drink?	Yes Socially No

Fun Questions

In Your Opinion Who Is The Perfect Guy
(To select multiple, please hold down the control key)

How Would You Best Describe Yourself?

The Last...

Book Read
Theatrical Play Attended
Concert Attended
CD Purchased

Goals and Aspirations

Goals
Aspirations

Anything Else Do You Want To Tell Me?