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Basic Registration Form
I'm a WOMAN looking for a relationship with a man aged
18
19
20
21
22
23
24
25
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79
80
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79
80
I'm a WOMAN looking for a job in Poland or abroad
I'm a MAN looking for a relationship with a Polish woman aged
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
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45
46
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48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
—
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
Country of Origin *:
-Select Country-
Albania
Argentina
Australia
Austria
Azerbaijan
Bahamas
Bangladesh
Belarus
Belgium
Bosnia and Herzegovina
Brazil
Bulgaria
Canada
Chile
China
Colombia
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Egypt
Estonia
Fiji
Finland
France
Georgia
Germany
Ghana
Greece
Hungary
Iceland
India
Italy
Iran
Iraq
Ireland
Israel
Jamaica
Japan
Jordan
Kazakhstan
Korea, South
Kuwait
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Mexico
Moldova
Morocco
Netherlands
New Zealand
Nigeria
Norway
Pakistan
Paraguay
Peru
Poland
Portugal
Romania
RPA
Russia
Scotland
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Taiwan
Tunisia
Turkey
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Venezuela
Country of Residence *:
-Select Country-
Albania
Argentina
Australia
Austria
Azerbaijan
Bahamas
Bangladesh
Belarus
Belgium
Bosnia and Herzegovina
Brazil
Bulgaria
Canada
Chile
China
Colombia
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Egypt
Estonia
Fiji
Finland
France
Georgia
Germany
Ghana
Greece
Hungary
Iceland
India
Italy
Iran
Iraq
Ireland
Israel
Jamaica
Japan
Jordan
Kazakhstan
Korea, South
Kuwait
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Mexico
Moldova
Morocco
Netherlands
New Zealand
Nigeria
Norway
Pakistan
Paraguay
Peru
Poland
Portugal
Romania
RPA
Russia
Scotland
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Taiwan
Tunisia
Turkey
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Venezuela
City *:
Province/Region *:
Phone No. **:
Keep Phone No. private (unavailable to other members)
Birthdate *:
-Month-
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
-Day-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-Year-
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
Language skills *:
Polish
-Select level-
Poor
Average
Good
Very good
English
-Select level-
Poor
Average
Good
Very good
German
-Select level-
Poor
Average
Good
Very good
French
-Select level-
Poor
Average
Good
Very good
Spanish
-Select level-
Poor
Average
Good
Very good
Italian
-Select level-
Poor
Average
Good
Very good
Russian
-Select level-
Poor
Average
Good
Very good
Other...
Education *:
-Select-
Primary school
High school
Bachelor's degree
Master's degree
PhD degree
Occupation *:
Employed (enter job title)
po polsku
in English
Unemployed
Full-time student
Retired
Ethnicity *:
-Select-
Black
American Indian/Alaskan
Asian
White
Hispanic
Indian/South Asian
Pacific Islander
Height *:
-Select-
< 5' (< 152 cm)
5' 0" (152 cm)
5' 1" (155 cm)
5' 2" (157 cm)
5' 3" (160 cm)
5' 4" (163 cm)
5' 5" (165 cm)
5' 6" (168 cm)
5' 7" (170 cm)
5' 8" (173 cm)
5' 9" (175 cm)
5' 10" (178 cm)
5' 11" (180 cm)
6' 0" (183 cm)
6' 1" (185 cm)
6' 2"(188 cm)
6' 3" (191 cm)
6' 4" (193 cm)
6' 5" (196 cm)
6' 6" (198 cm)
6' 7" (201 cm)
6' 8" (203 cm)
6' 9" (206 cm)
6' 10" (208 cm)
6' 11" (211 cm)
7' 0" (213 cm)
> 7' (> 213 cm)
Weight *:
-Select-
Below 80 lbs / 36 kg
80-90 lbs / 36-41 kg
91-100 lbs / 41-45 kg
101-110 lbs / 45-50 kg
111-120 lbs / 50-54 kg
121-130 lbs / 54-59 kg
131-140 lbs / 59-64 kg
141-150 lbs / 64-68 kg
151-160 lbs / 68-73 kg
161-170 lbs / 73-77 kg
171-180 lbs / 77-82 kg
181-190 lbs / 82-86 kg
191-200 lbs / 86-91 kg
201-210 lbs / 91-95 kg
211-220 lbs / 95-100 kg
221-230 lbs / 100-104 kg
231-240 lbs / 104-109 kg
251-260 lbs / 109-113 kg
261-270 lbs / 113- 118 kg
271-280 lbs / 118-122 kg
281-290 lbs / 122-127 kg
Above 291 lbs / over 127
Hair color *:
-Select-
Blonde
Gray
Bronze
Black
Red
Smoking *:
Frequently
Sometimes
Never
Pets *:
Like them
Indifferent
Dislike them
Username *:
Please specify at least 3 characters. Use only Latin alphabet characters, digits and _ sign.
Password *:
Please specify at least 6 characters. Use only Latin alphabet characters, digits and _ sign. Case sensitive!
Email ***:
Please enter a VALID email address which does not block automated emails from polishwomen.com domain name. A confirmation link will be sent to this email.
Confirm Email ***:
Keep Email Address private (unavailable to other members)
Verification Code *:
Verification code helps us prevent automated and spam registrations. Please enter it correctly before submitting the form. If you cannot recognize it, click on the "Reset Code" link for a new code and try again.
*
Fields marked with asterisk are mandatory to fill.
IMPORTANT!
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*** Your
encrypted
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