Party of Six Dinner and Entertainment

Interested in the possiblity of joining in a dinner for six with other eligible singles from Kingston, Ontario? Please submit your answers to this form as explained below.


Contact Information:
Email Address:
First Name:
Last Name:
Phone:
Please tell us about yourself:
Date of Birth: / /
Gender: Male Female
Height:
Weight:
Occupation:
Religion:
Do you smoke: Smoker Non Smoker
Do you have children under the age of 21: Children No Children
Athletic Interest:
Interests:
Sports (Select all that apply)

 

Golf
Tennis
Running
Biking
Football
Soccer
Baseball
Snowskiing

Scuba Diving
Hiking/Camping
Rock Climbing
Basketball
Rollerblading
Weight Training
Rowing
Swimming
Other Interests (Select all that apply) Theater
Ballet
Movies
Museums
Reading
Travel
Television
Dancing (Select all that apply) Ballroom
Swing
Nightclub
Country
Latin
Music (Select all that apply) Classic Rock
Pop Rock
Alternative
Classical
Jazz/Blues
Opera
Heavy Metal
Country
Tell us about the people you'd like to meet:
Age Preference: to
Smoker? Yes No Doesn't Matter
Do you have children: Yes No Doesn't Matter
Comments:

Please tell us anything additional about yourself that makes you unique. Here you can explain any "Other" answers you provided above.

 

To process your application, you must agree to these terms by typing AGREE in the following space:

Privacy Policy: We maintain a commitment to the privacy of our members.  Our policy strictly forbids that we sell or give out member information to third-parties.  Also, we do not accept solicitations for such information.

This form is not yet able to be used to submit data directly. However, you may copy and paste the information into a Word document and email it to nextlevelcc@yahoo.com.

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