Become a Distinguished Bachelor / Bachelorette

At Distinguished Bachelors we know that the more you have to offer the more difficult it is for you to find the woman or man of your dreams. For the most discerning men and women, Distinguished Bachelors gives you the added exposure you need to be as choosy as you are entitled to be. At Distinguished Bachelors our extensive marketing and the exposure our company gives your profile will provide you the opportunity to attract the type of men and women you are interested in meeting. When men and women submit their profile to meet you, they are screened, reviewed and presented to you. This gives you the opportunity to narrow your search and meet only the men and women that are just right for you.

All information is kept strictly confidential. Only the information you would like to appear on our site will be viewable by inquiring men and women. Your bio will be written for your review and approval before being submitted to our site. You may add or subtract information as you see fit. You may also add photos if you choose to.

If you are interested in becoming a Distinguished Bachelor / Bachelorette, please complete the application form below. You will be contacted shortly to discuss different pricing options. You may also call us at 212-242-4755.

Distinguished Bachelor / Bachelorette Application Form

Type (please choose your gender):	Bachelorette (Female) Bachelor (Male)
First Name:
Last Name:
Title:	Dr. Miss Ms. Mrs. Mr.
Address 1:
Address 2
City:
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachussets Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Primary Phone:
Fax:
Email:
How Shall We Contact you?	Phone Email
How Did You Hear About Us?
Promotional Code# if applicable:
Occupation:
Age:	18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75
Date of Birth:
Height:	4' 0" 4' 1" 4' 2" 4' 3" 4' 4" 4' 5" 4' 6" 4' 7" 4' 8" 4' 9" 4' 10" 4' 11" 5' 0" 5' 1" 5' 2" 5' 3" 5' 4" 5' 5" 5' 6" 5' 7" 5' 8" 5' 9" 5' 10" 5' 11" 6' 0" 6' 1" 6' 2" 6' 3" 6' 4" 6' 5" 6' 6" 6' 7" 6' 8" 6' 9" 6' 10" 6' 11" 7' 0"
Weight:	50 lbs 55 lbs 60 lbs 65 lbs 70 lbs 75 lbs 80 lbs 85 lbs 90 lbs 95 lbs 100 lbs 105 lbs 110 lbs 115 lbs 120 lbs 125 lbs 130 lbs 135 lbs 140 lbs 145 lbs 150 lbs 155 lbs 160 lbs 165 lbs 170 lbs 175 lbs 180 lbs 185 lbs 190 lbs 195 lbs 200 lbs 205 lbs 210 lbs 215 lbs 220 lbs 225 lbs 230 lbs 235 lbs 240 lbs 245 lbs 250 lbs 255 lbs 260 lbs 265 lbs 270 lbs 275 lbs 280 lbs 285 lbs 290 lbs 295 lbs 300 lbs
Body Type:	A few extra pounds Athletic Slim Petite Curvy Full Figured Stocky
Hair Color:	Auburn/Red Bald/Shaved Black Blonde Dark Blonde Dark Brown Light Brown Salt and Pepper Gray Silver White or Gray Colored/Highlighted Other
Eye Color:	Black Blue Brown Gray Green Hazel Other
Marital Status:	Single Married Divorced Widowed Legally Separated Never Married Check All That Apply
Body Décor (Tattoos, Piercings…)?	Yes No
If yes, describe:
Ethnicity:	Asian Black Caucasian/White Hispanic/Latino Arabic/Middle Eastern Mixed Race Native American Pacific Islander South Asian East Indian Other No preference
Religion:	Agonistic Atheist Buddhist/Taoist Christian Christian/Catholic Christian/Protestant Christian/Other Jewish Muslim/Islam Pagan Spiritual/Non Religious Other
Highest Level Of Education:	High school Some college Associates Degree/2-year college Bachelors Degree/4-year college Graduate/Masters Degree PhD./Post Doctoral Other
Annual Income Range:
About Me Describe who you are and what you are looking for in the person you want to meet. Where did you grow up? When did you move to your current location? What are your interests, hobbies, and activities? What types of activities do you use to keep in shape?
Are you interested in having children with a future partner?	Yes No Maybe No preference
Are you open to adopting children with a future partner?	Yes No Maybe No preference
Do you have any children?	Yes No
If yes, how many children do you have?	1 2 3 4 5 6 7 8 9 10
Where do your children live?	They live with me at home They sometimes live with me at home They live at boarding school/abroad I have adult (or grown)children They do not live with me
Are you willing to relocate?	Yes No Maybe
Do you smoke?	Yes No Socially
Do you drink?	Yes No Socially
Are you a Vegetarian?	Yes No
Do you play any instruments?	Yes No
If yes; what instrument(s)?
Politically you are?	Moderate Liberal Conservative Other
Fun Favorites
Favorite Food:
Favorite Restaurant:
Favorite Cocktail:
Favorite Bar:
Favorite Television Program:
Favorite Book:
Favorite Animal:
Travel
How often do you travel for business?
Languages spoken (fluent):	English Spanish American Sign Langauge French German Chinese Japanese Korean Portuguese Italian Polish Hebrew Russian Other
Not fluent:	English Spanish American Sign Langauge French German Chinese Japanese Korean Portuguese Italian Polish Hebrew Russian Other
Name three of your favorite travel destinations:
Name three destinations you’d like to travel to:
Seeking
Looking For:	Friendship Dating Long-term/Serious Relationship Marriage Casual/Intimate Check All That Apply
What is your dating age range?	From: 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 To: 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99
Ideal height range:	From: 4' 0" 4' 1" 4' 2" 4' 3" 4' 4" 4' 5" 4' 6" 4' 7" 4' 8" 4' 9" 4' 10" 4' 11" 5' 0" 5' 1" 5' 2" 5' 3" 5' 4" 5' 5" 5' 6" 5' 7" 5' 8" 5' 9" 5' 10" 5' 11" 6' 0" 6' 1" 6' 2" 6' 3" 6' 4" 6' 5" 6' 6" 6' 7" 6' 8" 6' 9" 6' 10" 6' 11" 7' 0" To: 4' 0" 4' 1" 4' 2" 4' 3" 4' 4" 4' 5" 4' 6" 4' 7" 4' 8" 4' 9" 4' 10" 4' 11" 5' 0" 5' 1" 5' 2" 5' 3" 5' 4" 5' 5" 5' 6" 5' 7" 5' 8" 5' 9" 5' 10" 5' 11" 6' 0" 6' 1" 6' 2" 6' 3" 6' 4" 6' 5" 6' 6" 6' 7" 6' 8" 6' 9" 6' 10" 6' 11" 7' 0"
Preferred Hair Color:	No preference Auburn/Red Bald/Shaved Black Blonde Dark Blonde Dark Brown Light Brown Salt and Pepper Gray Silver White or Gray Colored/Highlighted Other
Preferred Eye Color:	No preference Black Blue Brown Gray Green Hazel Other
Preferred Ethnicity:	No preference Asian Black Caucasian/White Hispanic/Latino Arabic/Middle Eastern Mixed Race Native American Pacific Islander South Asian East Indian Other
Preferred Religion:	No preference Agonistic Atheist Buddhist/Taoist Christian Christian/Catholic Christian/Protestant Christian/Other Jewish Muslim/Islam Pagan Spiritual/Non Religious Other
Distance willing to travel to date:	No preference 100 miles (160 km) 200 miles (320 km) 300 miles (480 km) 500 miles (800 km) 1000 miles (1600 km) Any Distance
Their annual income:
Would you date someone who is:	Never Married Divorced Widowed Has Children Has Children at home All of the Above Check All that Apply
Photos
Upload up to 3 photos for your profile: Photos must be .jpg files.	1) (Default Image) 2) 3)
Confidential Questionnaire
Any serious medical conditions?	Yes No
If yes, describe:
Been a patient at mental health facility?	Yes No
If yes, describe:
Been convicted for crime?	Yes No
If yes, describe:
* I would like my profile hidden except for members only.
* I would like my profile to be public for more exposure.
I would be interested in finding out about events and social networking opportunities in my area.
* I hereby declare (1) that the above information is accurate and true to the best of my knowledge and (2) that any material errors in the information I have provided will result in the immediate termination of my relationship with Club VIP Life and Distinguished Bachelors/ Distinguished Bachelorettes and forfeiture of all fees I have paid.

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