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Please leave your:
Name:
Alias/Nickname:
E-mail Address:
Web Address:
1} Are you:
Female
Male
Other
2} What brought you to this site?
Not Bitter Club Member's Site
Friend
A Dirty, Rotten Son Of A B****
Wandered In
Other
3} Did you:
Have a Mutual Break-up
Leave
Get left
File a Restraining Order
Have a Restraining Order Filed against you
Other
4} Who did this despicable thing to you?
Boyfriend
Girlfriend
Husband Wife
Other
5} What did He/She do to you?
6} What did you do in Retaliation?
7} After the above, were They:
Alive
Injured
Severely Injured
Missing Body Parts (ear, eye, leg, etc.)
Dead
Other
8} If you could change the above, what would your fantasy be?
9} Do you want your story used for:
Membership submission Only (completely confidential)
Posted online
Other
10} If used for Online Posting, which of the following would you like included: (click all that apply)
Name
Alias/Nickname
E-mail address
Web Address
11} What Catergory do you think that your story should be listed under?
Money
Best Friends
Bars
Sports Shopping
The Guys
The Gals
Other
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