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                                                MEMBER'S SUBSCRIPTION FORM



First name   M   F   Title

Last name 
      
Adress  
     
City  

Province/State/Department 
                            
Country   
                 
Zip/Postal code   
       
Phone number           -  - 
  
Email adress  
     
Date of birth    Day :    Month. :  Years : 
 
Marital statut   
    
Children   Girls :   Boys :
   
Car    Brand :  Years :
 
Work/Profession  
      
Last grade attempt   
   
ctivities/Leisure 
     
Spoken language     French :  English :   Others : 
  
Size        ft/m  in/cm
  
Weight        lbs/kg
 
Hair color  
     
Eyes color    
   
Smoker     Yes :   No :

SURVEY :

Do you want a forum?  Yes :   No :

Are you interest in participating to service exchange between member :   Yes :   No :
(traveling to another country for exemple with the help of the SCR)

Talk about yourself: 

N.B.: Please fill all the form and be as detailled as you can;  it will help us finding the best partner for you.
 
          If you want to join a personnal picture, it can help in order to better identify you for the other member;                 just joint it with you form when you email it.
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Cost for lifetime subscription: 40,00$ USD
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Payment can be made with:          

            
Create an e-gold account     #  580167

 Moneybookers  :  lavoie53@msn.com                      



                                           Check/MoneyOrder/Bank transfert avalaible on demand
                                                       (communicate with us by email for details)
                                                          ccr@clubdescelibatairesdelaroute.com                                                                                                                                                                                                                                                                                                                                                                                                                                      ___________________________________________________________________________________________               
Payment made the : Day :   Month:  Year : 

Confirmation number:  
                 
Payment made by:     E-gold           Paypal           Moneybookers

 I prefer paying by personnal check/money order/bank transfert   (wait for our email)
  
                    _________________________________________________________________________

Please before pressing on the SEND button, copy the entire filling form and paste it in your email

LOOK IN FRONT OF YOU, HAPPINESS AND JOY WAITS JUST BEFORE

THE SINGLE CLUB ON THE ROAD HAS THE SOLUTION FOR YOU


                  

N.B. If your email client does not support transfert by Outlook, just email with your regular email client 

to:       ccr@clubdescelibatairesdelaroute.com