MILLIONAIRE'S CLUB FEMALE CLIENT PROFILE
Please send your photos with contact #'s written on back & your signed client profile
form together. International applicants MUST include EMAIL ADDRESS to be considered.

Name:____________________________________________________________________

Contact #'s: H:____________________________W:_______________________________

Cell:_____________________Pager:_________________Email:____________________

1. Occupation:_____________________________________________________________

2. Address:______________________________________________________________

___________________________________________________________________________

3. Education level?________________________________________________________

4. Where did you go to college?____________________________________________

5. Where did you grow up?______________________________________________________

6. What is your ethnic origin?_______________________________________________

7. Age?________Birthday? (Please include month/day/year)______________________

8. Height?_______Weight?_______Hair Color?_______Eye Color?_______

9. Measurements? Bust_______(please include cup size) Hips______Waist_____

10. Have you ever been married? Y__N__

11. Are you legally separated? Y__N__
If so, you must show written proof of separation. (eg. copy of divorce petition and proof of living at a location different than your spouse) Please note that if you are not legally separated, membership will not be permitted.

12. Are you divorced? Y__N__
If so, you must provide a copy of the final decree of divorce. Please note that if you are still married you are not eligible for membership in this club.

13. Are you living with anyone? __________ If you are, what is their relationship to you? ____________________________________________________________________
*Please note that if you are not living at a location different than your ex, membership will not be permitted.

14. Do you have a criminal record: Y _____ N _____ If so, what have you been arrested for and/or convicted of:
_____________________________________________________________________________

15. Do you have an alcohol and/or drug addiction: Y _____ N _____
If so, which? _________________Have you obtained treatment?Y _____ N _____

16. Do you have or have you had any restraining orders against you: Y _____ N _____
If so, when and what was the reason: _______________________________________________

17. Do you have any children? Y__N__ Ages/Sex?_____________________________________________

18. Do you want children? Y__N__

19. Will you date a man with children? Y__N__

20. Do you smoke? Y__N__Do you drink alcohol? Y__N__

21. Religion you were you born with? Religion practicing today? (list both)

____________________________________________________________________________

22. When was your last long term relationship?___________________________________

23. How did you meet him?___________________________________________________

24. Why did the relationship end?_______________________________________________

________________________________________________________________________

25. Are you seeing anyone now? Y__N__

If so how serious is it?____________________________________________________

26. How did you hear about us?_______________________________________________

27. What are you looking for in a man?___________________________________________

28. What is more important looks or money?_______________________________________

29. What is your dating age range?______________________________________________
(remember men don't make serious money till they get into their 40's)

30. Would you date a man 10-15 years older than you? Y__N__

31. What is the minimum height requirement of a man you will date?_____Max height?_____

32. What ethnic origins do you feel comfortable dating?________________________________

______________________________________________________________________________

33. What do you do to keep in shape?_____________________________________________

_____________________________________________________________________________

34. What are your favorite restaurants in your area?___________________________________

_____________________________________________________________________________

35. What are your favorite fashion designers?______________________________________

36. What are your favorite vacation spots?__________________________________________

_____________________________________________________________________________

37. Favorite sports to watch and/or play?________________________________________

38. Would you be willing to relocate? Y__N__

39. Do you have any pets? Y/N____What kind?_____________________________________

40. Are you allergic to any pets? Y/N____What kind?_________________________________

41. Did you use a Millionaire's Club Photographer Y/N?____If so who?________________

Would you consider appearing on/in:  (Please check yes or no to the following)

Various news spots such as CNN, CBS, NBC, ABC, Rob Report 9, The Oprah Show, Entertainment Tonight, or Access Hollywood etc.?
Y____________N____________

Various magazines or newspapers such as Maxim, People, Glamour etc.?
Y____________N____________

A major network reality television show based on the Millionaires Club concept?
Y____________N____________

A theatrical movie based on the life of the owner of the company?
Y____________N____________

Please note: If you are married you are not eligible for membership in the Millionaire's Club. If you are legally separated you may still be eligible for membership, but will have to show a copy of your court stamped copy of the Petition for Dissolution together with proof that you are living apart from your spouse (eg. apt./house rental agreement, etc.)

I allow the Millionaires Club to use my photograph for advertising, editorial and promotional purposes and on the Millionairesclub.150m.com website.

I represent and warrant to Millionaire's Club that: (i) I am at least 18 years of age; (ii) I am either single, widowed, divorced or legally separated (and living apart from my spouse); (iii) I have no undisclosed physical or mental health problems, patterns of substance abuse or criminal record; and (iv) the information I have provided in this Client Profile is complete, true and accurate.

I shall not, without the prior written consent of Millionaire's Club, publish, whether in writing or by means of electronic media, any information regarding Millionaire's Club or the Millionaire's Club dating and match making services ("Services").

During the term that I am a member of Millionaire's Club and for a period of three years following the termination of my membership, I shall not directly or indirectly or through an affiliate solicit for business purposes any person (including for this purpose any individual, firm or entity) that is or has been a member, client or employee of Millionaire's Club at any time within the five full calendar years preceding the termination of my membership.

If I provide services to a client in violation of the preceding paragraph, either directly or through an affiliate, I shall pay as damages to Millionaire's Club upon receipt from the client an amount equal to 20 percent of the gross fees earned, net of reimbursable expenses collected from the client with respect to such services. I shall so pay Millionaire's Club upon receipt of funds from the client. I shall make my books and records available to Millionaire's Club's accountant to enable Millionaire's Club to verify the amount payable pursuant to this provision.

I agree to indemnify, defend and save harmless Millionaire's Club from and against any and all losses, damages, liabilities, claims, demands, causes of action, lawsuits and expenses (including reasonable attorneys' fees and expenses) that Millionaire's Club may incur, or that may be threatened against Millionaire's Club, arising out of or in connection with (a) my use of the Services, (b) any breach or violation of this Agreement by me, or (c) my negligence or willful misconduct.

Millionaire's Club does not conduct background checks on any of its members and assumes no liability for the accuracy of the information provided by any of its members. In no event shall Millionaire's Club be liable to me for any damages, direct or indirect, arising out of the use of the Services, including, but not limited to, damages arising out of communicating and/or meeting other members or the acts of other members (including, but not limited to, property damage, bodily injury and emotional distress).

In the event in a change in your marital status (i.e. you get married); you promise to notify Millionaires Club immediately.

I represent that the information I have provided in this Female Client Profile Form is complete, true and accurate and agree that I will promptly notify Millionaire's Club of any change in the information provided in this Female Client Profile Form.

Dated:____________________ Name:___________________________________________

Please send photos and client profile forms to:
Millionaire's Club Corporate Office
4712 Admiralty Way #234, Marina Del Rey, CA 90292
No photos can be returned and we do not accept registered mail.

All requests pertaining to photos (i.e., changes, removals from the website, etc. must be made VIA E-MAIL ONLY, (see contact us section) and require sixty (60) days notice from the time of the initial request
--- NO EXCEPTIONS!

Copyright 2001 The Millionaire's Club Inc., All Rights Reserved.