BlackMontreal.com
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JOIN BLACKMONTREAL!
Some potential advantages (national and international)
G
roup discounts,
common interests, unity, friendship,
community building, news and views
PLEASE FILL IN AND SEND THE FORM BELOW:
BlackMontreal.com Membership application
What is today's date? (DD-MM-YY)
Are you male or female?
Male
Female
What is your pre-name?
Mr.
Miss
Mrs.
Ms
What is your first name?
What is your lastname/surname?
What is your email address?
What is your telephone number?
What is your full mailing address?
What is your age group?
under 13
13 to 15
16 to 20
21 to 24
25 to 29
30 to 34
35 to 39
40 to 45
46 to 49
50 to 60
61 to 64
65 and over
What are your interests? (Check as many as you like)
Social events (parties, dances, barbeques, picnics etc.)
Travel (bus rides, air travel, cruises, vacations etc.)
Shopping (clothes, home electronics, hardware, food etc.)
Meeting people for friendship
Meeting for love
Making money (Business etc.)
Do you have any comments?
BlackMontreal.com
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