Christian Singles Dating - membership form

Join Christian Singles

click here to print this form

(Please print from your browser, complete and SEND to the address below.)

Name:..................................................................................................................................................................................

Marital Status:......................................................................................................................................................................

Nationality:..........................................................................................................................................................................

Age:.........................Sex:.............................Kidz:................................................................................................................

Address: .............................................................................................................................................................................

.............................................................................................................................. Postcode: .....................................

Country: ............................................................................................................................................................................

Phone: Home: ...................................................................... Work: ......................................................................

Mobile: ...................................................................... Fax: ......................................................................

E-Mail:..................................................................................................................................................................................

Occupation:.........................................................................................................................................................................

Denomination:.....................................................................................................................................................................

Height:.............................................................................. Weight: ........................................................................

Hair Colour:...................................................................... Eye Colour: ........................................................................

I have enclosed Photo: Yes: No:

My Interests: ........................................................................................................................................................................

............................................................................................................................................................................................

What I'd like in a contact, date or pen-friend:

............................................................................................................................................................................................

Where did you hear about us eg: newspaper, magazine, friend, internet etc: ........................................................................

............................................................................................................................................................................................

BENEFITS can be: New friendships, sharing, learning different cultures and even romance!

Code of Conduct: I will conduct myself in a Christian manner and I am over the
age of 18 years.

Signature: ........................................................................................................................................

Date: ............................................................................................................

Christian Singles

Six months membership is ONLY AUD$69.00 (inc. GST) A maximum of 10 names are sent
Comprehensive AUD$99.00 (Unlimited available first names and phone numbers, email addresses and details about singles for 6 months) A maximum of 20 names are sent to get you started! After you join, your first name, phone number, email address is sent on to all the new appropriate singles. This will even give you more contacts!
We try to give you the:
1. the first names of singles & their phone numbers, email address in your area
2. otherwise, we give you the details of singles in other areas, states and countries
3. a combination of the above
Forming christian friendships is also important

-conditions apply

Christian Dating

Is for professional, business and like minded singles!

Six months membership is ONLY $89.00 or Concession $79.00 (Unlimited available first names, phone numbers, email addresses and details about singles for 6 months). A maximum of 20 names are sent to get you started! After you join, your first name, phone number and email address are sent on to all the new appropriate singles. This will even give you more contacts!
Comprehensive Offer is ONLY $99.00 (Unlimited available first names, phone numbers, details, email addresses, photos where available). A maximum of 20 names are sent to get you started! After you join, your first name, phone number, photo, email address is sent on to all the new appropriate singles. This will even give you more contacts!
Photos are presented on hand made coloured photo holders for more IMPACT!

-conditons apply

If you ONLY want to ring singles, please tick box.
If you do NOT want your photo sent out to singles, please tick box.

Note, singles who exchange photos receive MORE phone calls, emails, etc.

I have enclosed a cheque, Money order or cash for AUD$............................
(payable to Christian Singles or John Gibala)

Please debit my:
Mastercard Visa Diners

Name:..................................................................................................................................................

Address:..............................................................................................................................................

............................................................................................................... Postcode:..........................

Phone:................................................................................................................................................

Cardholder account number:

Card Expiry Date:.........................................................................

Amount in Figures AUD$...................................................................

Signature: ...................................................................................

Date: ...........................................................................................

Christian Singles & Dating
5 Grange Ave, MARYLAND 2287, Australia
PO Box 122 WALLSEND 2287, Australia

Phone and Fax: 02 49555 445
Mobile: 0417 88 40 88
International Phone and Fax +61 2 4955 5445

E-mail: singles@christiansingles.com.au
Web Site: www.christiansingles.com.au