Given Name:
Last Name:
Address:
City:
State:
Country:
Postal code:
Phone Business:
Phone Home:
Your email address:
Fax Number:
Date of birth:	Day: Month:Year:

Myself		My Partner
Sex		Sex
Age		Age (range)
Height (Metric)		Height (Metric) - range
Height (Imperial)		Height (Imperial) - range
Smoker	No Yes	Smoker	No Yes Not Important
Nationality		Nationality
Land of Origin		Land of Origin
Ethnicity	African American Caucasian Asian Latino or Espano Other	Ethnicity
Marital Status	Single Divorced Widowed Legal Separation	Marital Status	Single Divorced Widowed Legal Separation Not Important
Number of Children		Children	Not Important No Yes
Boys/Girls - ages/how many
Living with Own Child/Children	No Yes	Living with Child/Children	No Yes Not Important
Highest Education Level Attained	No category selected Secondary School Some Tertiary Study Degree or Diploma Master or higher	Highest Education Level Attained	No category selected Secondary School Some Tertiary Study Degree or Diploma Master or higher Not Important
Education		Education
Occupation Category	No category selected Retired or permanently not working Student or brief unemployment Blue collar or clerical Professional or Middle Management Top Professional or Senior Executive	Occupation Category	No category selected Retired or permanently not working Student or brief unemployment Blue collar or clerical Professional or Middle Management Top Professional or Senior Executive Not Important
Occupation		Occupation
Disability or Ill Health		Disability or Ill Health
Looking for	Friendship Companionship Marriage Other	Looking for	Friendship Companionship Marriage Other
List Sporting Activities		List Sporting Activities I would like to share with my partner
List Cultural Activities		List Cultural Activities I would like to share with my partner
List interests, hobbies other activities		List interests, hobbies and activities I would like to share with my partner
Qualities that best describe myself		Qualities I seek in my partner

This space is provided for any further information or comments you wish to relay to me

A message from Carolyne || About Carolyne || Why approach a Matchmaker? || The Matchmaker of Olde
Testimonials || Questionnaire || Epilogue

Carolyne Hardwick & Assoc.
PO Box 388 St Ives NSW 2075 Australia Info-Fone Australia Pty. Ltd. ABN 18064342196
Telephone:	Australia 02 9440 0477	International: +61 2 9440 0477
Facsimile:	Australia 02 9449 6430	International: +61 2 9449 6430
email: carolyne@matchmakermatchmaker.com
Contact Us At Any Time

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