Please fix the following input errors: dummy First Name * Last Name * Date of Birth Gender * --Select-- Male Female Email * Mobile Phone # Office Phone # Home Phone # Availability --Select-- Morning 8am-10am Late Morning 10am-12pm Afternoon 12pm-3pm Late Afternoon 3pm-6pm Evening 6pm-9pm Late Evening 9pm-11pm Weekend only Anytime Street Address 1 City State --Select-- Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas U.S. Virgin Islands Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Zip/Postal Code Country --Select-- Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic of the Cook Islands Costa Rica Cote D'Ivoire (Ivory Coast) Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati South Korea North Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela VietNam Virgin Islands, British Virgin Islands, U.S. Wallis And Futuna Western Sahara Yemen Zambia Zimbabwe South Sudan Vatican City State (Holy See) Do you own or rent? Own Rent Do you own or rent? cannot be empty Where did you grow up? About Me (Who I am) Hair Color --Select-- Brown Blonde Red Blue Grey Black Mixed Auburn Salt & Pepper Eye Color --Select-- Brown Blue Green Hazel Black Grey Height --Select-- Less than 5'ft (Less then 152cm) 5'ft (152-154cm) 5'1"ft (155-156cm) 5'2"ft (157-159cm) 5'3"ft (160-162cm) 5'4"ft (163-164cm) 5'5"ft (165-167cm) 5'6"ft (168-169cm) 5'7"ft (170-172cm) 5'8"ft (173-174cm) 5'9"ft (175-177cm) 5'10"ft (178-179cm) 5'11"ft (180-182cm) 6'ft (183-184cm) 6'1"ft (185-187cm) 6'2"ft (188-190cm) 6'3"ft (191-192cm) 6'4"ft (193-195cm) 6'5"ft (196-197cm) 6'6"ft (198-200cm) 6'7"ft (201-202cm) 6'8"ft (203-205cm) 6'9"ft (206-207cm) 6'10"ft (208-210cm) 6'11"ft (211-212cm) 7'ft (213cm) More than 7'ft (More then 213cm) Body Type --Select-- Slender Athletic Average A few extra pounds Large Petite Fit Curvy Ethnicity --Select-- Caucasian African-American Hispanic/Latino Asian Middle Eastern Asian Indian Native American Multi-Ethnic Other Black Chinese Pacific Islander Malay Eurasian East Indian Are you open to dating outside your race? No Yes Are you open to dating outside your race? cannot be empty If yes, please listThis field cannot be empty Religion --Select-- All Agnostic Atheist Buddhist Christian (Catholic) Christian (Protestant) Christian (Other) Hindu Muslim Jewish Pagan & Earth-Based Scientology Taoist Unitarian Universalist Spiritual, not religious Other Free Thinker Religious Importance Important Not Important Very Important Religious Importance cannot be empty Education Level --Select-- High School Some College Associates Degree Bachelor's Degree Graduate Degree PhD & Above Masters Degree Professional Qualification Diploma Advanced Diploma Polytechnic Junior College & Below A Levels & Below Undergraduate School Graduate School Graduate School Degree Received Employment Status Employed In-Between Jobs Retired Self-Employed Employment Status cannot be empty Occupation Annual Income --Select-- Less than $50,000 $50,000 to $75,000 $75,000 to $100,000 $100,000 to $150,000 $150,000 to $200,000 $200,000 to $250,000 $100,000 to $250,000 $250,000 to $500,000 $500,000 to $1M $1M to $3M More than $3M Willing to relocate --Select-- No Yes Relationship Goal Committed Relationship Dating Marriage Marriage and Family Relationship Goal cannot be empty Relationship HistoryCommitted relationship but never married Long time single Never been in a committed relationship Previously married Widowed This field cannot be empty If you have married before, are you now:Divorced Separated Widowed This field cannot be empty How many times have you been married?This field cannot be empty Length of marriage(s)This field cannot be empty If divorced, how many times?This field cannot be empty If pending divorce, when will divorce be final?This field cannot be empty If separated or widowed, for how long?This field cannot be empty Do you have children? --Select-- Yes - living at home full-time Yes - living at home part-time Yes - they are adults No Yes Tel us about your last serious relationshipThis field cannot be empty Length and when did it end?This field cannot be empty Describe your longest relationship Smoking Habits --Select-- No Light / Social Yes Drinking Habits --Select-- No Light / Social Yes Exercise Habits --Select-- Never or very infrequent Once every 3 months Once a month A few times a month A few times a week Every day Politically you are? --Select-- Conservative Liberal Moderate Other Animals I OwnThis field cannot be empty Animals I Like Hobbies Are you a vegetarian? --Select-- No Yes Favorite Restaurant Favorite Music --Select-- Acapella Acoustic/ Live All Kinds alternatives Blues Chinese Songs Classical Club Contemporary Country Folk Hard Rock Hip-Hop/ Rap Independent Indian music Instrumental Japanese Songs Jazz Latin Light and Easy Lounge Mandarin Pop Musical/ Broadway/ Movie New Age Opera Pop R & B Retro/ Oldies Rock Sentimental Soft Rock Soul Soundtracks Spiritual Trance/ House/ Techno Gospel Favorite Films --Select-- Action Action Adventure Adventure All Kinds Animation Anime Art Artistic Cartoon Chinese Chinese Sword Fighting Classics Comedy Crime Detective Thrillers Documentaries Drama Fantasy Fiction Foreign Films French Historicals Horror Inspirational Light hearted Movie Musicals Musical Non-Fiction Non-Horror Others Real Life Stories Romance Romance Comedy Science Fiction Soap Opera Spiritual Thriller War War Romance Favorite Bar I am (An Introvert is a 0, and Extrovert is a 10) --Select-- 0 1 2 3 4 5 6 7 8 9 10 Do you have a positive outlook and think things will turn out for the best or do you worry about things that could go wrong? Are you more old-fashioned? (Man pays, feminine address, Mom raises children) or Modern day? (Pay 50/50 for dinners and nannies for kids) What are the three things for which you are most thankful? What is the first thing people notice about you? What do you do on the weekends and in your spare time? Name three of your favorite travel destinations Name three destinations you'd like to travel to What do/did your parents do for a living? Is family important to you? How often do you speak with them? Any serious medical conditions? --Select-- No Yes Been a patient at mental health facility? --Select-- No Yes Been convicted for crime? --Select-- No Yes If yes to any of above, please explain About My MatchThis field cannot be empty Match Gender * --Select-- Male Female Both First Preference Second Preference Flexibility Match Age --Select-- 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 to --Select-- 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 --Select-- 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 to --Select-- 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 --Select-- Not Flexible Moderately Flexible Extremely Flexible First Preference Second Preference Flexibility Match Body Type --Select-- Slender Athletic Average A few extra pounds Large Petite Fit Curvy --Select-- Slender Athletic Average A few extra pounds Large Petite Fit Curvy --Select-- Not Flexible Moderately Flexible Extremely Flexible First Preference Second Preference Flexibility Match Religion --Select-- All Agnostic Atheist Buddhist Christian (Catholic) Christian (Protestant) Christian (Other) Hindu Muslim Jewish Pagan & Earth-Based Scientology Taoist Unitarian Universalist Spiritual, not religious Other Free Thinker --Select-- All Agnostic Atheist Buddhist Christian (Catholic) Christian (Protestant) Christian (Other) Hindu Muslim Jewish Pagan & Earth-Based Scientology Taoist Unitarian Universalist Spiritual, not religious Other Free Thinker --Select-- Not Flexible Moderately Flexible Extremely Flexible First Preference Second Preference Flexibility Match Ethnicity --Select-- All Caucasian African-American Hispanic/Latino Asian Middle Eastern Asian Indian Native American Multi-Ethnic Other Black Chinese Pacific Islander Malay Eurasian East Indian --Select-- All Caucasian African-American Hispanic/Latino Asian Middle Eastern Asian Indian Native American Multi-Ethnic Other Black Chinese Pacific Islander Malay Eurasian East Indian --Select-- Not Flexible Moderately Flexible Extremely Flexible First Preference Second Preference Flexibility Match Education Level --Select-- High School Some College Associates Degree Bachelor's Degree Graduate Degree PhD & Above Masters Degree Professional Qualification Diploma Advanced Diploma Polytechnic Junior College & Below A Levels & Below --Select-- High School Some College Associates Degree Bachelor's Degree Graduate Degree PhD & Above Masters Degree Professional Qualification Diploma Advanced Diploma Polytechnic Junior College & Below A Levels & Below --Select-- Not Flexible Moderately Flexible Extremely Flexible Previously married okNo Yes This field cannot be empty First Preference Second Preference Flexibility Match Wants to have children? --Select-- Yes, I definitely want to have Maybe, I am not sure I definitely DO NOT want to have kids --Select-- Yes, I definitely want to have Maybe, I am not sure I definitely DO NOT want to have kids --Select-- Not Flexible Moderately Flexible Extremely Flexible First Preference Second Preference Flexibility Match Smoking Habit --Select-- No Light / Social Yes --Select-- No Light / Social Yes --Select-- Not Flexible Moderately Flexible Extremely Flexible First Preference Second Preference Flexibility Match Drinking Habit --Select-- No Light / Social Yes --Select-- No Light / Social Yes --Select-- Not Flexible Moderately Flexible Extremely Flexible Match Dealbreakers How did you hear about us? Brochure Internet LinkedIn Media Meetup Other Referral How did you hear about us? cannot be empty If referral, who referred you?This field cannot be empty Have you ever used a dating service and/or Matchmaker? No Yes Have you ever used a dating service and/or Matchmaker? cannot be empty If yes, which one(s) and when?This field cannot be empty What was the result?This field cannot be empty Photo Allowed file-types are gif, jpg, jpeg, pjpeg, png The maximum file size limit is 5 MB Extra Photo #1 Extra Photo #2 Extra Photo #3 I'm interested in becoming a client; please contact me.No Yes This field cannot be empty I give East Coast Match permission to share my profile with a possible client match. no yes I give East Coast Match permission to share my profile with a possible client match. cannot be empty