Please fill out the Single CEO club profile to help us learn more about you. We never will share your personal information with any 3rd party what so ever! This information remains private and is used by our internal staff to maintain a profile on our active members.

NAME_____________________________________________________ AGE______________

ADDRESS____________________________________CITY_______________ZIP___________

HOME TEL. # (______)__________________WORK # (________)______________________

E-MAIL ADDRESS_________________________________@___________________________

OCCUPATION___________________________________TITLE__________________________

EMPLOYER___________________________________________________________________

HEIGHT___________________  WEIGHT____________  HAIR COLOR___________________

COLLEGES ATTENDED_________________________________________________________

ADVANCED DEGREES?__________________________________YEAR FINISHED________

MARITAL STATUS____________________________            HOW LONG?________________

AGE OF CHILDREN___________________________DO CHILDREN LIVE WITH YOU_______

HOBBIES/ACTIVITIES THAT YOU LIKE TO DO______________________________________

_____________________________________________________________________________

DO YOU SMOLE?______________ DO YOU DRINK__________________________

DO YOU WORK OUT?___________________HOW OFTEN?___________________________

WHERE DO YOU NORMALLY GO ON VACATION?__________________________________

_____________________________________________________________________________

HOW MANY VACATIONS DO YOU TAKE PER YEAR?_______________________________

HOW DO YOU SPEND YOUR FREE TIME?_________________________________________

______________________________________________________________________________

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Please mail your profile form to:

THE SINGLE CEO’S CLUB

PO Box 1095

Lynnfield, MA 01940

Phone (617)721-9655