Perfect Harmony
 
EXAMPLE OF ENROLMENT FORM
  
   
SURNAME:
FIRST NAME(S):
E-MAIL ADDRESS:
ADDRESS:
POSTCODE:
HOME: OFFICE: OTHER:

PLEASE STATE THE MOST CONVENIENT TIMES TO CONTACT YOU:
(In strictest confidence. The name of our company will not be left, only my own personal name)
 
DATE OF BIRTH:
NATIONALITY:
HEIGHT (FT.):
WEIGHT (ST.LB.):
OCCUPATION:
DO YOU ENJOY GOOD HEALTH? YES NO
IF NO, PLEASE GIVE DETAILS:
STATUS:
SINGLE
SEPARATED
DIVORCED
WIDOW(ER)
DO YOU HAVE ANY CHILDREN? YES NO
IF SO, DO THEY LIVE WITH YOU? YES NO
 
HOW WOULD YOU DESCRIBE YOURSELF?
EXTROVERT
SHY
SOCIABLE
INTERESTS OR HOBBIES:

PLEASE GIVE BRIEF DETAILS OF THE KIND OF PERSON YOU WOULD LIKE TO MEET.
(We will use our best endeavours to meet realistic requests)

AGE RANGE: FROM TO
PLEASE STATE ANY FOOD YOU DO NOT EAT:
DO YOU SMOKE? YES NO
 
DO YOU WISH TO PAY BY:
CHEQUE
OR CREDIT CARD?

Please send cheques to:
Perfect Harmony Dining Club,
9, The Coppins,
Harrow Weald,
Middlesex
HA3 6DT

  

If you wish to pay by credit card, make sure you have entered a phone number we can reach you at.. We will then call you to take your card details.
All dinners must be pre-paid.
Cancelled bookings will be refunded, up to 48 hours beforehand.
All information given is treated in the strictest confidence.
The management reserves the right to refuse membership.
 
VAT REGISTRATION NUMBER: 662 9868 78