Signup – Companion Outreach

Note: Allow time for the website to upload the file and submit the registration.

Name: *

First

Middle

Last

Birthdate: *

Enter your date of birth

Nationality: *

Weight: *

Please specify pounds (lbs) or kilograms (kgs)

Height: *

Please specify height in feet (') and inches (") OR in meters (m)

Occupation: *

Education: *

Place of birth: *

Religion: *

Marital Status: *

Number of Kids: *

Enter the number of children you have. Enter 0 for none.

Personality: *

Favorite activities: *

Do you smoke or drink? *

Are you willing to relocate? *

Please indicate Yes or No if you're willing to relocate, should you find a suitable match on Companion Outreach.

Type of gentleman you desire to meet: *

Eligible gentleman may contact me via: *

Select the method of contact you're most comfortable with.

Age range of your ideal companion: *

WhatsApp phone number: *

Email: *

Confirm Email

Please enter a valid email address that can be used to reach you.

Picture Upload: *

Click or drag a file to this area to upload.

File size cannot exceed 20MB. Accepted image formats: JPEG, JPG, PNG, BMP, and WEBP.

If you're wearing dark sunglasses, hoodies or anything that obscures your face (including masks), your registration will be rejected.

Country of residence: *

How / where did you hear about our club *