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Please read the following
before signing up, and then...

Please complete the following form...
(Please note that all fields are required, this form will not post untill all fields have been completed!)

Personal Details
First Name
Last Name
Once your account has been created, your login username will be your email address by default.
For your security, we suggest you use your grandmother's name.
Gender Male Female
Please enter your birth date in the following format (yyyy/mm/dd) - include slashes.
Date of Birth
Marital Status
Height (cm)
Ages of Children
Do you smoke?
Country of Birth
Country of Residence
Whilst most of my clients are more spiritually inclined nowadays, please select what religion you were born into as this is quite an important part of your heritage and will give the onlooker a better insight into your background.
Contact Details
Designation / Job Title
Name of Business
Business Phone
Home Phone
Cell Phone
Would you like extra external exposure, or limit exposure to members only?
Access (Check to restrict profile to members only)
Open to dating other races? All White Indian Mixed Race Black Other
Qualities you are looking for in a partner?
(Please enter each point on a new line)
Hobbies and Interests
Please describe your hobbies and interests below...
(Please enter each point on a new line)
Upload Photo's

Select Portfolio Pictures...
You can select multiple pictures per browse. Each browse will replace the previous selection.
Please select photo's for your profile. These should include:
  • One Formal / Cocktail Wear
  • One in Holiday / Casual Wear
  • One CLOSE-UP (Head & Shoulders)
  • Lastly, one holding a can of Coca-Cola (So I know the picture is recent.)
  • To select multiple pictures while choosing files - merely hold down your control button while selecting the images.

Select copy of your ID document...
You may only select one ID picture per browse. Each browse will replace the previous selection.
Please include a copy of your id.

I accept the terms of the
indemnity form


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