Exclusive Introductions by Gina Hendrix

Want Gina to keep you in mind for one of her great clients?

Then please take a few moments and fill out the information on this form and upload at least one photo of yourself. There is no charge to be in the database. Once we have your profile information, you will be contacted by Gina to set up an in person interview. If Gina feels you are a match for one of her clients, you will be contaced and given details of a prospective match. All fields in the form are required to be filled out or your profile information will not be uploaded into the database.

**Make sure all of your information is true and can be verified. All of your information is strictly for Gina's eyes only, her clients will never see your profile.

Tell me about yourself...

Please note that all fields require an answer and at least 1 photo (jpeg format) must be submitted.

First Name:

Last Name:

Address:

City:

State:

Zip:

Phone:

Email:

Occupation:

Education:

Date of Birth:

Marital Status:

Children:

Ethnicity:

Religion:

Sex/Gender:

Sexual Preference:

Height:

Weight:

Hair Color:

Eye Color:

Do You Smoke?:

Do You Drink?:

Where did you grow up?:

If any, what college or university did you attend?:

What are your hobbies or interests?:

What is your true passion in life:

Your 1st Photo:

at least 1 photo required (jpeg only)

Your 2nd Photo:

Your 3rd Photo:

Now tell me what you're looking for...

What is your ideal "type"?:

What would be the best qualities of your match?:

Desired age range:

Desired Race:

Height Requirements:

Weight Requirements:

Eye Color:

Hair Color/Style:

Smoking:

Drinking:

Religion:

How important is the person's income:

What are the top three most important things that you seek in a partner:

What is the absolute "deal breaker"? It can be more than one:

Is your goal marriage:

Is your goal to have children or more children:

What if this person already has children:

Do you like animals or have any animals:

What was your longest relationship?:

Why did it end?:

How did you here about Exclusive In LA?:

Note: In order to successfully submit this form you must provide an answer for every question. If no answer applies... please enter N/A.
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