GENTLEMEN'S SUBMISSION FORM

PLEASE TELL US ABOUT YOURSELF

Please take a few moments to complete this form:
(All fields are optional but tell us as much as you can.)

I am currently in or plan to visit (check all that apply):
Moscow, Russia
 St. Petersburg, Russia
 Kiev, Ukraine
 Riga, Latvia
 Minsk, Belarus
 Novosibirsk, Russia
 Almaty, Kazakhstan
List other cities:
When do you plan to arrive? How long do you plan to stay?
Do you have a valid Russian (or Ukraine) visa now? Yes No
Do you need help to obtain a visa? Yes No

First Name: Age:
Height: Weight:
In what city, country are you now? (as you complete this form.): Where are you originally from?
Eyes: Hair:
Occupation: Marital Status:
Religion: Kids:
Age group of partner: Interests / Hobbies:
More about me: Her kids:

 

 Kids OK No kids
Languages spoken: How did you find us?(Newspaper, internet, etc.)
What is your Russian speaking level?
It's OK if you don't speak any Russian but this question will help us understand which ladies you can communicate with.

I am studying Russian

   

The following information will be kept 100% confidential.
This is for our internal use only and will not be shared with anyone including the ladies.

Full Name: Primary email account:
 ! Your email address will be kept confidential and not shared with anyone.
This is where we will send your responses to. Please be sure to check this account at least once per day.


^Type your email again
Secondary email account:
 Please provide us a secondary email account in case we can not reach you on your primary.		 Home Telephone:
Work Telephone: Mobile Telephone:
Please provide at least one contact telephone number. This is for a number where ladies can reach you (we do not give your number out without your permission.)
Special notes or instructions: Mobile Phone Provider:
Please let us know the name of your mobile phone provider, ie. T-Mobile, Cingular, Beeline, Megafone, MTC, etc. in case we need to send you an SMS.
Send me SMS notifications about ladies who agree to meet.
 Include me in the Gentlemen's Catalogue to women (optional, remove anytime.)
Enter me in your monthly Moscow draw (one free meeting awarded every month.)

! Important: Please be sure you have a working email and to check it often as this is where we send your responses to.


I have a valid major credit card (or PayPal) to pay for meetings (cash not accepted.)
 I can afford your meeting fee should you find the right person for me (pay nothing now.)


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