Gentlemen's Application

We are pleased to extend to you our confidential application to be part of what has become the most exclusive private club of highly eligible singles. Please complete the form below and one of our staff will contact you. We will go over our membership packages as well as invite you for an in-person interview at which time we will ask you to complete a much more extensive questionnaire. At your in-person interview we will also discuss our service in great detail, introduce you to our network and answer any questions you may have. Welcome to Amy Laurent International.

***All members' privacy is protected and full confidentiality guaranteed at all times
*** Confidentiality Contracts are available.

Name (first/last)
Address
City
State
Postal Zip Code
Country
Best Contact #
Best Time to Reach
Home Phone
Work Phone
Cell Phone
Fax #
Email Contact
Age
Date of Birth
Height
Weight
Hair Color
Eye Color
Place of Employment
Occupation
Address
How did you hear about us?
What is your marital status?
What is your desired dating age range?
Please briefly describe what qualities are important to you in a woman. (You will fill out a more extensive questionnaire should you sign with us, so a few sentences is sufficient)