First, tell us a little about yourself.

First Name *
Last Name
Age *
Gender *	-- Select -- Male Female
Ethnicity *	-- Select -- Asian/Pacific Islander Black/African American Indian Latin/Hispanic Middle Eastern Native American White/Caucasian Other
Address
City	, TX
Zip
Primary Phone Number *	Cell Home Work
Secondary Phone Number	Cell Home Work
Best Time to be Contacted	-- Select -- Noon Early Afternoon Late Afternoon Early Evening Late Evening Does not matter
Email Address *
How did you hear about CSA? *	-- Select -- Dallas Morning News Mail – Post Card Personal Referral Online Radio – 94.9 KLTY Radio – 660 KSKY Radio – The Ticket Other
Promotion Code
Required(*)

Next, tell us a bit about the person you would like to meet.

Their Age Range	From:  To:
Their Education Level	-- Select -- High School Junior College Degree College Degree Post Graduate Degree Does not matter
Their Denomination	-- Select -- Catholic Protestant Baptist Assembly of God Church of Christ Pentecostal Non-denominational Not important to me Other
Their Church Involvement	-- Select -- Doesn´t attend church Attends on special holidays Attends when they can Attends weekly Is very actively involved Not important to me
Their Parental Status	-- Select -- Childless Has children No children at home Not important to me
Wants Children	-- Select -- Yes No Not important to me
Their Fitness / Lifestyle	-- Select -- Athletic Very Active Active Occasionally Active
Their Body Type	-- Select -- Slender Athletic Curvy Muscular A few extra pounds Larger Not important to me
Most Important Characteristic to Me	-- Select -- Looks Spirituality/Religious Practice Personality Intelligence Social Status

Finally, please share a few details about yourself
to help us find your perfect match.

Marital Status	-- Select -- Never Married Divorce in Progress Divorced Widowed
Fitness / Lifestyle	-- Select -- Athletic Very Active Active Occasionally Active
Body Type	-- Select -- Slender Athletic Curvy Muscular A few extra pounds Larger
Church Involvement	-- Select -- I don´t attend church I only attend on special holidays I attend when I can I attend weekly I am very actively involved
Denomination	-- Select -- Catholic Protestant Baptist Assembly of God Church of Christ Pentecostal Non-denominational Other
Parental Status	-- Select -- No children Young children at home Older children at home No children at home
Education Level	-- Select -- High School Junior College Degree College Degree Post Graduate Degree
Occupation
Annual Income	-- Select -- Under $15,000 $15,000 to $25,000 $25,000 to $35,000 $35,000 to $50,000 $50,000 to $100,000 $100,000 +
Typical Work Hours	-- Select -- 9-5 Afternoon through evening Late-night shift My time is my own I am not working now
Social Situation	-- Select -- I am new to the area I do not meet enough quality people I am too busy to look for people I have not been dating in months
Dating Status	-- Select -- Not dating Not dating anyone special Dating someone who is not "the one"
When was your last fun date?	-- Select -- 0-6 Months About 1 year 2 years or more Too long
How long ago was your last serious relationship?	-- Select -- 0-6 Months About 1 year 2 years or more Too long
Why did your relationship end?