Please complete the following information Your information will be used to determine your eligibility for membership and to help us introduce you to and seat you with others that share similar interests and backgrounds. Annual membership is $ 98.00
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Name:
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Occupation:
College Degree:   Associate   Bachelors   Masters   Doctorate College Attended: College Major: I tend to be more: Outgoing & Talkative Quiet & Reserved I am a: Male Female Smoker Non-smoker Single Status: Never Married Divorced Widowed
Birthday:	--- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec -- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ---- 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980
I enjoy . . . (check all that apply)
Music Dancing Movies Theater Art Photography Traveling Museums/History Reading Church Swimming Snorkeling/Scuba Camping Hiking Horseback Riding Amusement Parks Chess/Other Games Cooking Gardening Computers/Internet Football Basketball Baseball Boxing Skiing Ice Skating Hockey Auto Racing Tennis Racquetball Boating Fishing Volleyball Roller Blading Bicycling Motorcycling Bowling Running Golf Walking Other Interests
My favorite cuisines are
American Italian Oriental Mexican Greek German French
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Delightful Dining Inc.
551 Roosevelt Rd., #318
Glen Ellyn, IL 60137

Phone: 630.588.8289    Fax: 630.588.8689

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