The form below is a very important tool in helping me know a little about you.  It is imperative for you to for you to fill this out to completion, as best you can.  I require a board presence (handle, datecheck, p411 id).  I require provider references that are the most recent, so that I can contact them for verification.

On a personal note, I apologize  if you are under the age of 30 I'm going to automatically decline.  It's a personal choice so please do not get offended. I just feel that I do not have anything in common with younger guys. I like to take my time learning things about a refined man who has established his likes and dislikes in life.  Who appreciates taking his time with a woman as well.

Also, if you feel that screening is not for you, I sincerely apologize you feel that way, but I am not the girl for you