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    Please fill in every field. If something does not apply to you, type "NA"
  1. Type your first, middle, and last name.
  2. (list all previous names)
  3. Or best number to reach you.
  4. Please copy and paste the full link, not just your name.
  5. If so, please explain. Otherwise, type "NO"
  6. If yes, Passport #, Country of Issue, and expiration date
  7. (What do you do for a living and for what company? What pays the bills?)
  8. Please list the school (Include location), courses studied, and any degrees obtained.
  9. Please explain.
  10. If you believe a partner’s religion may have an impact on your relationship, please explain what would and would not work for you and why.
  11. If you believe a partner’s race and/or ethnicity may have an impact on your relationship, please explain what would and would not work for you and why.
  12. If a partner’s gender identity may have an impact on your relationship, please explain what would and would not work for you and why.
  13. If you believe a partner’s sexual identity may have an impact on your relationship, please explain what would and would not work for you and why.
  14. Tell us about it.
  15. Please explain your answer.
  16. (Roommates, parents, kids, still living with your ex, alone, etc…)
  17. Please explain.
  18. Check all that apply.
  19. Otherwise type "N/A"
  20. Please explain. Otherwise type "NA"
  21. Otherwise type "NA"
  22. If so, please list as applicable, including the name of the show/film/online or other content and the release/air dates
  23. If yes, how many cigarettes in a day?
  24. If yes, how much and how often?
  25. Email / Phone / Instagram / Flyer / Etc
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  31. * For verification purposes pursuant to 18 U.S.C. §§ 2256 et seq.

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