Maryland's Upscale Singles
Online Member Directory

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Private Information
The following information will be kept confidential and is for the exclusive use of Maryland's Upscale Singles and will NOT appear on the online Member Directory.
Title	Ms. Mr. Dr.
First Name
Last Name
Street Address
City
State
Zip Code
Work Phone
Home or Cell Phone
How Did You Hear About Us?
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	Name of Publication, Website or Friend (if applicable)

Personal Information and Interests
The following information will be used to create your profile. Other members will be able to view this information on the online Member Directory.
First or Nickname
Last Name
E-mail	Check if you do not want your email displayed. Members will not be able to contact you.
Your City
Marital Status	Single Divorced Widowed Separated
Occupation
Age
Gender	Male Female
Height:
Weight:
Body Type:	Slender A few extra pounds Heavyset     Athletic and toned About average Other
Exercise Habits:	Never Exercise 3-4 times per week     Exercise 1-2 times per week Exercise 5 or more times per week
Religion:
Interests and Hobbies
About me:
I am looking for:
NOTE: Please allow up to 24 hours for your online member directory profile to be uploaded.

Billing Information
If your Billing Information is the same as above, you may proceed to the  "Payment Method" section.
Your Name as it appears on Credit Card
Your Billing Address
City
State
Zip Code
Payment Method
	Annual Subscription $25.00
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Total Amount
Credit Card Number
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Expiration Date	mm 01 02 03 04 05 06 07 08 09 10 11 12   yyyy 2007 2008 2009 2010 2011 2012 2013 2014
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