P.O. Box 4081, Hornchurch, Essex, RM12 5AZ, England Tel: 01708 500585 On-Line Membership Application Form

Join on-line today. Simply complete the form below and click the 'Submit' button at the bottom of the page. You will then be taken to a payment page on a secure server where you can securely pay either by Credit or Debit Card or by your PayPal account.

First Name						Last Name
House Number or Name							Join Today Pay by Credit/Debit Card or pay by
Street Name
Town/City
County (if not applicable enter 'N/A')
Post Code
Tel. No:						e-mail

Marital Status

Weight

Age

Height

Occupation
Number and ages of children:
Your Hobbies/Interests
Your Character description
Age range of ladies you wish to meet:
Marital status of ladies you wish to meet:
Would you accept a lady with a child ?
Please enter below a description of lady you wish to meet. This includes her education, personality, interests and appearance.
Do you wish to receive our colour photo brochure of Russian ladies in Britain?
Would you like to go on a trip to Moscow or St. Petersburg to meet the ladies ?
Would you like to attend Russian socials in London ?
Please state where you saw our advert or state an Agent Reference number if you were asked to quote one.
If you would prefer to apply by post, please print and complete this application form and sign and date it below. Then return the form to us together with your cheque/postal order/bankers draft for the membership fee of GBP 165 made payable to 'IFM Russian Introductions'. If you would like your details to appear in our on-line brochure which is accessed by our lady members please also enclose a clear photo of yourself or email it to us later. By signing this form/clicking the submit button below I confirm that the above information is accurate and that I have read and agree to the membership terms on this web site (www.intromoscow.co.uk) and wish to apply for membership of IFM Russian Introductions.
Signed:.....................................					Date:......................................