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Print :this page, fill it out and mail it,PERSONAL & CONFIDENTIAL:Name: _______________________________________________________________________________ Address:______________________________________________________________________________ Addres_______________________________________________________________________________ City: ________________________________________________________________________________ State/Province:_________________________________________________________________________ Country:______________________________________________________________________________ Postal Code: __________________________________________________________________________ Telephones:____________________________________________________________________________ Fax _________________________________________________________________________________ E-mail: _______________________________________________________________________________ YOUR PUBLIC PROFILE ON THE INTERNET: Online Name:__________________________________________________________________________ Nationality__________________________Date of Birth:________________________________________ Number of Children: ____________________________________Marital Status______________________ Height: _____________________Weight: _____________________Eye Color:______________________ Occupation: ___________________________________Education: _______________________________ Smoke? _____________________________Religion: _________________________________________ Languages I speak: ______________________________________________________________________ Describe what kind of person you are,and your favorite activities: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Describe your ideal mate and ideal relationship: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ _______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ _______________________________________________________________________ Signature:___________________Date: ______________________ INCLOUD: your close up color photos. 2 or 3 approximately 3 x 5 inches photographs. E-mail: form and photos to; girlsofbrazi@yahoo.com MAIL: SEND THIS FORM AND PROFESSIONAL PHOTOS TO, Girls of Brazil Introduction Agency: PO BOX 345 Bethesda MD 20814 USA |