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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.
   
ABOUT YOU
Title: Mr Mrs Ms Miss
Other:
Forename:
Surame:
Address:  
Postcode:
Accommodation Type :  
Terraced Semi Detached Detached
Apartment Bungalow Flat
Tel no :
Work Tel no
Mobile no:
Pivate email:
When is the best time to be contacted?
Morning Evening  
How would you like members to contact you?
Home Mobile  
Age:  
Date of birth  
Your height:  
Your weight (Gents)
Your dress size (Ladies)
Your Hair Colour:  
Your Eye Colour:  
Nationality:
Country of Origin
Your Appearance :
Asian
Black/African Other
Do you have any Children?
Yes No  
Ages  
How many live with you?
   
Do you live?    
Alone With Parents
With Children

 
Marital Status  
Single never married Divorced
Separated Widowed
   
Your Occupation
 
Approx. Income (Per Annum)
Do you smoke?    
Trying to give up
Your Eductional Level
College
Education Qualifications:
No Educational Qualifications
GCSE or Equivalent
A Level or Equivalent
Technical Qualifications
Other
What Languages do you speak?  
 
Your political Views:  
Right
What is your religion?  
C of E Catholic
No Strong Convictions
Are You:    
Practising
Do you drive?    
Yes-Own a car
Hold License-no car
What make of car do you drive ?
Colour of car
Registration no
What is your preferred travelling distance?
10-45 Mins Up to an Hour

 
 
How would you, your family and friends describe your personality?
What are your future goals and ambitions?
YOUR INTERESTS    
What activities do you do?    
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 Wrting 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 Amatuer Dramatics Collecting Antiques
Are you involved in any other activities?
Are there any new activities you would like to try?

 

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
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 Mowtown
Reggae Easy Listening Indie
Rock 60's 70's
80's 90's Country & Western.
Do you play any musical instruments?
(Specify)
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?
Never    
What kind of drinks do you prefer?
Beer Wine Spirits
My last five holiday destinations?  
What would be your ideal holiday?  
What type of holiday do you prefer?
Activity Cultural Sightseeing
Adventure Beach/Relalxing
Other
What types 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:

 
.
WHO I'D LIKE TO MEET: (PLEASE TICK ANY OR ALL)
Aged between and
Preferred marital status:
Will you meet someone with children?
Yes No
Yes, if independent  
How many children would be acceptable to you?
Height between:  
Minimum Maximum
Build:    

 

  
Will you meet a smoker?  
Yes No Casual
Preferred appearance:  
Caucasian/white European Asian
Mixed Race Middle Eastern Far Eastern
Black/Africa Descent  
Distance you are willing to travel?
10-45mins Up to an hour The Northwest
Education level:    
School College University
Job level:    
Skilled Semi Professional Managerial
Professional Retired Entrepreneurial
Creative & Media Financially Independent
How did you hear about Select?

Best time to call you?

Declaration: I confirm that I a 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.

 

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