Contact Information:
Email Address:

First Name:
Last Name:
Street Address:
Address 2:
City:
State:
Zip Code:
Work Phone:
Home Phone:
Cell Phone:

Please tell us about yourself:
Date of Birth:	/ /
Gender:	Male Female
Height:
Weight:
Occupation:
Employer:
Area of the country you were raised in:
Annual Income:
Education:
Name of College/University:
Religion:
Do you smoke:	Smoker Non Smoker
Do you have children under the age of 21:	Children No Children
Athletic Interest:

Comments:
Please tell us anything additional about yourself that makes you unique. Here you can explain any "Other" answers you provided above. Also, let us know about any special dietary needs you might have.

Please indicate the best time and date for you to stop by our 345 Queen Street location for an interview with our representative. Interview appointments can be made from 9-6 Monday thru Friday, and 12-4 on Saturdays. Please choose a day that is at least 1 week from today. You will be contacted to confirm this time well in advance of the appointment.

How did you hear about Party of Six?:

Each person attends events sponsored by Party of Six at his/her own risk, and Party of Six shall not be liable for any loss or injury sustained, either directly or indirectly, by any such person. In consideration of the privilege of attending events sponsored by Party of Six, patrons waive any and all claims they or their heirs may have against Party of Six, its owners, Managers, and employees. Furthermore, Party of Six reserves the right to decline to schedule any individual for any future dinners or other events sponsored by Party of Six for any reason, whatsoever.

To process your application, you must agree to these terms by typing AGREE in the following space:

Privacy Policy: We maintain a commitment to the privacy of our members. Our policy strictly forbids that we sell or give out member information to third-parties. Also, we do not accept solicitations for such information.

Interests:
Sports (Select all that apply)	Golf Tennis Running Biking Football Soccer Baseball Snowskiing Scuba Diving Hiking/Camping Rock Climbing Basketball Rollerblading
Other Interests (Select all that apply)	Theater Ballet Movies Museums Reading Travel Television
Dancing (Select all that apply)	Ballroom Swing Nightclub Country Latin
Music (Select all that apply)	Classic Rock Pop Rock Alternative Classical Jazz/Blues Opera Heavy Metal Country

Tell us about the people you'd like to meet:
Age Preference:	to
Smoker?	Yes No Doesn't Matter
Do you have children:	Yes No Doesn't Matter