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  1. Type your first and last name.
  2. (list all previous names)
  3. Location.
  4. Or best number to reach you.
  5. Please copy and paste the full link, not just your name.
  6. If so, please explain. Otherwise, type "NO"
  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 political views may have an impact on your relationship, please explain what would and would not work for you and why.
  12. 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.
  13. (Please check as many as apply)
  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. Otherwise type "N/A"
  19. Please explain. Otherwise type "NA"
  20. Otherwise type "NA"
  21. If so, please provide details and dates. (You should exclude convictions more than two years old for any marijuana offense, convictions for which the record has been judicially ordered sealed, expunged, or statutorily eradicated, and any misdemeanor conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed
  22. If so, tell us about it. Give details, including, without limitation, date(s), place(s), name of party seeking the temporary restraining order and relationship of such party to you, and a description of the basis upon which the temporary restraining order was sought, whether it was issued, and the basis upon which it was issued.
  23. If so, please explain in detail. Otherwise type "NA"
  24. If so, please list as applicable, including the name of the show/film/online or other content and the release/air dates
  25. If yes, how many cigarettes in a day?
  26. If yes, how much and how often?
  27. If no conflict, type "NO CONFLICTS"
  28. Email / Phone / Instagram / Flyer / Etc


  29. If so, provide their NAME, PHONE NUMBER and EMAIL ADDRESS.
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  32. Please check the box above to indicate that you have read, understand and agree to the above terms.
  33. Use your mouse or finger to sign above
  34. Please Select

  35. * For verification purposes pursuant to 18 U.S.C. §§ 2256 et seq.

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