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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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