Encounters International Survey Form

After fully completing this form and clicking "Send It" below,

Note: This form contains fields. Some browsers do not support fields. If no fields appear below, please email the indicated information to us at:
natasha@encount.com

1. Your Name (First Middle Last) Example: John Q. Sample


2. Home Address:


3. Home Phone Number: Example: 301-530-7759


4. Email Address:
* valid email required


5. Place of Birth, Date of Birth and where you were raised:


6. Age: Height: Weight:


7. Occupation:


8.Educational Background:
High School
College
Masters
Ph.D.
Other:

9. Marital Status:
Never Married
Separated
Divorced
Widowed

10. Number of Children and their Ages:
Number:
Ages: (Example: Sons: 6 & 10, Daughter: 12)


11. My interests include ...


12. I can say about my self that ...


13. I would like to meet a woman who ...


14. What type of other information would be important
      for you to have from our website?


15. What types of additional services would you like to see us provide to
      both visitors and members?


16. Have you tried or been a member of any other marriage agencies before
      and if so, what type?


17.Annual Income:
Up to $20K
          $20K to $40K
          $40K to $60K
          $60K to $80K
          $80K to $100K
          Over $100K

18. Where did you find out about EI's Web page? What Search Engine did you use?


19. (Optional)Why I Want To Marry A Russian Woman
      If you answer this part of the survey, you will be automatically included in the
      contest to win a one month free membership in Encounters International.
      Also, your answer will give us an opportunity to know you better and provide you
      with the highest level of our personalized service.







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