DATEABLE MEMBERSHIP
APPLICATION FORM


Thank you for your interest in DateAble, Inc. We are a non-profit introduction/dating service for people with and without physical disabilities. Most of our members are located throughout the United States, and we even have a few from around the world. Turn off pop-up blockers to access help pages.

General Information


 
Gender (required):   
 
Where did you first learn about DateAble? (required)
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Personal Information



Education: Choose the highest school year completed (required):
   
   
 
Do you smoke? (required)
 
Do you drink? (required)
 
Are you visually impaired? (required)
 
Do you use a wheelchair? (required)
 
Do you have dependent children living with you? (required) ,  
 
 
Are you currently employed? (required) ,
 

Personality Traits


Please check 10 traits from the following list that describe you best.

Don't understand a word or need a definition? (opens in a new window)

Traits (10 required)
 

Interests and Activities


Using the following activities scale, please indicate how much you enjoy the interests and activities listed below. Enter the number 2 for those activities that you like a great deal; enter the number 1 for those activities that you merely like; enter 0 or leave fields blank for those activities you have no interest in. You must select at least one activity you enjoy.

Interests and Activities (required)


 
 
 
 

Prospective Matches


DateAble exists to facilitate friendships between individuals towards a dating experience. Sometimes because of members' preferences it is not possible to match individuals with other members. If Dateable, Inc. cannot facilitate this process; we are not responsible for any refund issued to a DateAble member.

Are you willing to date a smoker? (required)
 
Are you willing to date someone who is visually impaired? (required)
 
Are you willing to date someone who drinks? (required)
 
Are you willing to date someone in a wheelchair or scooter? (required)
 
Are you willing to date members of... (required)
 
Specify the age range of those you would like to date (required):
 
Specify the height of those you would like to date (required):
 
Specify the weight of those you would like to date (required):
 
Specify all races of those you would like to date (required):
 
Specify all religions of those you would like to date (required):
 

 

 
Are you interested in being a Pen Pal?
 

Membership Dues


A one year membership is $125.00.

Payment Options (required):

Please send check payments to:
     DateAble
     15520 Bald Eagle School Road
     Brandywine, Maryland 20613

     (Please do not send cash)

 

Referrals


Please send information about DateAble to the following people:

   

One of the ways in which DateAble, Inc. expands its membership is through referrals. If the referral entered above results in membership with DateAble, your account will be credited $25 towards the following year's membership dues.

 

Agreement


Please read and check each of the following statements:

 
 
 
 

Click Submit Application to send application, and continue to process payment.