Please fix the following input errors: dummy First Name * Last Name * Gender * --Select-- Male Female Enter your full name to verify that you have read and agree to all terms in the Application Agreement and Terms of Service.This field cannot be empty Mobile Phone # Email * Date of Birth About Me (Who I am) 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 Willing to relocate --Select-- No Yes Describe what you are looking for in the person you want to meet Street Address 1 City State --Select-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia 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 Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming 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 Zip/Postal Code Hair Color --Select-- Brown Blonde Red Blue Grey Black Body Type --Select-- Slender Athletic Average A few extra pounds Large Petite 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) Education Level --Select-- High school Some college Associates degree Bachelors degree Graduate degree PhD / Post Doctoral Masters Degree 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 Political Affiliation Conservative Liberal Moderate Not Political Other This field cannot be empty What religion are you currently practicing? --Select-- Agnostic All Atheist Buddhist Christian (Catholic) Christian (Other) Christian (Protestant) Hindu Jewish Muslim Other Pagan & Earth-Based Scientology Spiritual- not religious Taoist Unitarian Universalist What religion are you currently practicing? cannot be empty Ethnicity --Select-- Caucasian African-American Hispanic/Latino Asian Middle Eastern Asian Indian Native American Multi-Ethnic Other Do you have children? --Select-- Yes - living at home full-time Yes - living at home part-time Yes - they are adults No Yes Do you want to have children? --Select-- Yes, I definitely want to have Maybe, I am not sure I definitely DO NOT want to have kids Would you date somebody who has children?This field cannot be empty Would you like to appear on Patti's television show? No Yes Would you like to appear on Patti's television show? cannot be empty How did you hear about us?This field cannot be empty