APPLICATION
for Membership in SINGLE PARENTS USA!
Code #: __________________________
(Assigned by Single Parents USA)
Please print out this form, fill in the
requested information and mail along with your payment to:
SINGLEPARENTSUSA.COM
3337 WEST FAIRCREST DRIVE, ANAHEIM, CA 92804-3014
Name:
Address:
Phone #H:
Phone #C:
Email Add:
Write in your pass word protected profile listing:
If you wish us to write your profile listing: (Optional but required if you wish
to have access to other member profiles):
Sex __ M __ F Height Ft: __ Inches__ hair color ____ eye color: _____
ethnic background _______________, religion ___________,
Education: __________
Occupation _________, Smoker: __ Y __ No Drinking: __ Y __ N
Interest, Hobbies, Pastimes (What you enjoy):
Please circle the 7 to 10 words that best describe you: romantic liberal conservative carefree quiet marriage-minded
outgoing sensitive intellective affectionate religious
considerate open-minded sense of humor self-confident exciting
serious trusting athletic loyal optimistic sincere emotional
Type of person that you would like to meet:
About your child/children, name(s) age(s), hobbies etc:
Note: I authorize SINGLE PARENTS USA to edit and publish the information contained
herein. SINGLEPARENTSUA.COM cannot guarantee the accuracy of any information supplied by its members. I understand that giving
false information about myself can and may be considered cause for my membership being terminated without refund!
I will not hold SINGLEPARENTSUSA.COM responsible for any dealings between myself
and any person(s) that I contact or
who contacts me through SPUSA.
IMPORTANT NOTICE: All applicants
must meet qualification requirements! SPUSA reserves the right to deny membership to anyone if we believe that to allow membership would not be in the best interest
of SPUSA and/or it's members.
If a member decided to cancel his/her membership before 90 days of full membership SPUSA will give that member a FULL refund. However, if a member is canceled by SPUSA for cause, there will be no refunds made.
We will do all that we can to protect the privacy and well being of our members!
Sign. of Applicant: _____________________________ Date: _______________
Categories of Membership (please select only one)!
SINGLEPARENTSUSA.COM
3337 WEST FAIRCREST DR ANAHEIM, CA 92804-3014 - (Map)
VM: 1-800-844-9639 X 4547
