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Name
Street
City
State
Zip
E-Mail
Phone
Birth Date	- -
Gender
Do you have children?	Yes
Do you prefer a mentor with a similar age?	Yes
Do you prefer a mentor of the same gender?	Yes
Tell us about yourself. Include hobbies, interests, career - anything that might help us find you a good match.
What skills do you need help with? Such as shopping, cooking, dining out, meeting new people, etc.
How would you describe your current diet?
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