Part B

MPI APPLICATION FORM - CONFIDENTIAL - Ph 03 9646 4928 or Fax (03) 9646 5403

Apply PART A PART B

Part B. The people I would like to meet - If no strong preference, write "OPEN"

Age range to

Height range to

Build:

Slim/Average

Full Figure/Solid

Athletic

Open

Character and personality preferred:

Educational standard preferred:

Would you consider meeting someone who has dependent child/children?

Yes

Regular/weekend access

Unsure (depends on situation)

Comments:

If you met the right client, would you consider having (more) children in the future?

Yes

Open (if met the right person)

Any religious preferences?

Any ethnic preferences?

Any skin complexion preferences?

Any further comments/preferences (including what qualities you seek in your partner):

Your aims/goals with MPI:

Do you have any restriction on contact details MPI can supply to clients? (Ladies need to tick 'Yes')

Yes If yes, please detail

First Introduction:	_________________________________________
Signed:	_________________________________________	Date:	___________________
I heard of MPI from: E&OE. Subject to variation.

Preferably, print blank form and complete by hand. In any case, do not overrun text boxes. Please bring the completed forms to your meeting with Andrew.

MPI APPLICATION FORM - CONFIDENTIAL - Ph 03 9646 4928 or Fax (03) 9646 5403

Apply PART A PART B