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What is your idea of a good night out?
 
Visit to the theatre or opera
 
Romantic dinner for two
 
Karaoke at the local pub
 
Drinks and then clubbing
 
Watching a football game
 
 
 
Which of these would be your ideal holiday?
 
Activity-based, e.g. skiing
 
A luxury hotel in New York
 
Exploring the Far East
 
Lying on a beach in the sun
 
A cottage in the country
 
 
 
How would you best describe your character?
 
Shy and reserved
 
Expressive, open and chatty
 
Humorous, but hide feelings
 
Uncomplicated, easy-going
 
 
 
What are the most important characteristics in a partner?
 
Good looks and style
 
Loyal, kind, trustworthy
 
Sense of fun, love of life
 
Dynamic, successful
 
Passionate and adventurous
 
 
 
How would you describe your parents' marriage?
 
Up and down but good
 
They separated/divorced
 
Not close, but stayed together
 
Happy, affectionate, loving
 
Acrimonious, argumentative
 
 
 
What were your family's financial circumstances?
 
Affluent, plenty for all of us
 
Comfortable
 
Struggling, money was tight
 
Varied from lots to little
 
 
 
Choose three traits you least like in someone
 
Messiness
 
Infidelity
 
Unreliability
 
Meanness
 
Selfishness
 
No ambition
 
Poor dress sense
 
Negative attitude/sulkiness

 
 
 
Smoke?
 
Yes
 
No
 
 
 
Name
   
Address
   
Work Phone
   
Home Phone
   
 
 
 
Are you...

 
Female
 
Male
 
 

Do men know what women want?
 
Yes
 
No
 
Will never know!
 
 
 
If you are female... Which of the following would you want most from your significant other this Valentines Day?


If you are male... Which of the following do you think your significant other would want most this Valentines Day?








 
Flowers
 
Candy
 
Romantic dinner
 
Jewelry
 
Lingerie
 
To hear "I Love You"
 
A kiss
 
Sex
 
Other (Please Specify)
 
 
 
How romantic do you expect this Valentines Day to be?
 
Very Romantic
 
Moderately Romantic
 
Not At All Romantic
 
 
 
Is Valentines Day the best day of the year to get engaged?






 
Yes
 
No
 
Maybe
 
 
 
What's most important to you when choosing a significant other?









 
Good looks
 
Shared interests
 
Intelligence
 
Money
 
Humor
 
Sensitivity
 
Romance
 
Friendship
 
Other (Please Specify)
 
 
 
What is your age?

 
Less than 18
 
18-24
 
25-29
 
30-39
 
40-49
 
50-59
 
60-69
 
70 or more
 
 
 
What is my name?
   
 
 
 
Where did we meet?
   
 
 
 
How long have you known me?
   
 
 
 
Do I smoke?
   
 
 
 
When you first saw me, what your impression?
   
 
 
 
How old am I?
   
 
 
 
What is my birthday?
   
 
 
 
Do I watch football?
   
 
 
 
How many siblings do I have?
   
 
 
 
Am I shy or outgoing?
   
 
 
 
Am I a rebel or do I follow all the rules?
   
 
 
 
Can I sing?
   
 
 
 
If there were one good nickname for me, what would it be?
   
 
 
 
Am I right or left handed?
   
 
 
 
Have I ever been in love?
   
 
 
 
Would you ever go out with me?
   
 
 
 
Am I a good friend?
   
 
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