General Information
First Name (required):
Middle Name:
Last Name
(required):
Gender (required):
Male
Female
Street Address
(required):
City
(required):
State/Province
(required):
not available
Alabama
Alaska
Alberta
Arizona
Arkansas
British
Columbia
California
Colorado
Connecticut
Delaware
Dist
of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New
Brunswick
Newfoundland
and Labrador
New
Hampshire
New
Jersey
New
Mexico
New
York
North
Carolina
North
Dakota
Northwest
Territories
Nova
Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince
Edward Island
Quebec
Rhode
Island
Saskatchewan
South
Carolina
South
Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West
Virginia
Wisconsin
Wyoming
Yukon
Zip/Postal Code (required):
Country
(required):
United
States of America
Afghanistan
Åland
Islands
Albania
Algeria
American
Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Barbuda
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia
and Herzegovina
Botswana
Bouvet
Island
Brazil
British
Indian Ocean territory
British
Virgin Islands
Brunei
Darussalam
Bulgaria
Burkina
Faso
Burundi
Cambodia
Cameroon
Canada
Cape
Verde
Cayman
Islands
Central
African Republic
Chad
Chile
China
Christmas
Island
Cocos
(Keeling) Islands
Colombia
Comoros
Congo
Congo,
Democratic Republic
Cook
Islands
Costa
Rica
Côte
d'Ivoire (Ivory Coast)
Croatia
(Hrvatska)
Cuba
Curacao
Cyprus
Czech
Republic
Denmark
Djibouti
Dominica
Dominican
Republic
East
Timor
Ecuador
Egypt
El
Salvador
Equatorial
Guinea
Eritrea
Estonia
Ethiopia
Falkland
Islands
Faroe
Islands
Fiji
Finland
France
French
Guiana
French
Polynesia
French
Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard
and McDonald Islands
Honduras
Hong
Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao
People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan
Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall
Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands
Antilles
New
Caledonia
New
Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk
Island
Northern
Mariana Islands
North
Korea
Norway
Oman
Pakistan
Palau
Palestinian
Territories
Panama
Papua
New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto
Rico
Qatar
Réunion
Romania
Russian
Federation
Rwanda
Saint
Helena
Saint
Kitts and Nevis
Saint
Lucia
Saint
Pierre and Miquelon
Saint
Vincent and the Grenadines
Samoa
San
Marino
Sao
Tome and Principe
Saudi
Arabia
Scotland
Senegal
Serbia
and Montenegro
Seychelles
Sierra
Leone
Singapore
Slovakia
Slovenia
Solomon
Islands
Somalia
South
Africa
South
Georgia and the South Sandwich Islands
South
Korea
Spain
Sri
Lanka
Sudan
Suriname
Svalbard
and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad
and Tobago
Tunisia
Turkey
Turkmenistan
Turks
and Caicos Islands
Tuvalu
Uganda
Ukraine
United
Arab Emirates
United
Kingdom
United
States of America
U.S.
Virgin Islands
Uruguay
Uzbekistan
Vanuatu
Vatican
City
Venezuela
Vietnam
Wales
Wallis
and Futuna Islands
Western
Sahara
Yemen
Zaire
Zambia
Zimbabwe
Telephone #
(required):
E-Mail
(required):
Website (do
not enter http://):
Date of Birth
(required):
Age (required):
Where did you first learn about DateAble?
(required)
Personal Information
Education: Choose the highest school year completed
(required):
Do you smoke?
(required)
Yes
No
Do you drink?
(required)
Yes
No
Are you visually impaired?
(required)
Yes
No
Do you use a wheelchair?
(required)
Yes
No
Do you have dependent children living with you?
(required)
Yes ,
What are their ages?
No
What means of transportation do you use?
(required)
Car
Public
Transportation
Other
If other, please specify:
Are you currently employed?
(required)
Yes ,
What is your occupation?
No
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)
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)
Use this space to elaborate on
the interests and activities listed above. (for example, if you
play a musical instrument, what instrument do you play). Please
add any other activities and interests you enjoy that are not
listed (required).
Please use this space to tell us how we should describe you to other DateAble members
(required).
Do you have a disability? If
so, please describe briefly and indicate if you use a wheelchair
or motorized scooter.
Please use this space to tell us more about what you are looking for in a dating relationship
(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.
Membership Dues
A one year membership is $125.00.
Payment Options
(required):
Mail Check
Online through Pay Pal
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:
I acknowledge that submission of this application
does not guarantee membership with DateAble, Inc. I understand that upon review of my application I will
receive acknowledgement of my request to join DateAble, Inc.
I understand that it is my responsibility, and not a third
party's responsibility to contact DateAble, Inc. regarding my membership, including parents, guardians, and any other
third party.
I understand that DateAble, Inc. is only one vehicle
in which to facilitate friendships and/or dating relationships.
Click Submit Application to send application, and continue to process payment.
Disclaimer:
Members should understand that DateAble, Inc. cannot authenticate statements made by its members, nor can it be responsible for the actions of any member or non-member. In consideration for participating in DateAble, Inc., members waive all claims to that effect, agreeing in addition that DateAble's liability for performing or not performing any service on behalf of its members shall be limited to the amount of the membership or renewal fee. As an additional consideration of membership, it is further understood that submission of false information will result in immediate termination without a refund.