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Name:

Age:

Legal name as it appears on your state-issued i.d.:

Current Street Address:

City:

State:

Zip code:

Cell Phone:

Alternate Phone:

Email:

Emergency Contact Name:

Emergency Contact Phone:

I am a lawful U.S. Citizen (Check one):

Where is your primary residence? :

How long have you been with your partner? :

Are you:

about to be engaged

engaged

newlyweds

If engaged or newlywed, who proposed and how? (Please be specific) :

Do you currently live together? If yes, how long? :

Do you have any children together? (if YES, please list ages) :

What is a special and unique quality about your relationship? :

What is your favorite thing to do together?:

Where have you traveled on vacation?:

What is the most lavish gift that was given or received?:

Where do you spend most of your social time?:

Describe your upbringing?:

Describe your education. Where did you study? List any degrees or titles.:

What is your reputation amongst your peers professionally, socially and personally?:

How are you remembered? What impression do you make?:

Describe any philanthropic endeavors that you, or your partner, are associated with. :

How do your combined experiences make you an amazing couple? :

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