Premium Membership Application Form

First Name *

Last Name *

Email *

Phone *

WhatsApp (if different)

City & Country

Gender *

Ethnicity *

Nationality *

Languages spoken *

Highest Education Level Completed *

Birthdate *

Relationship Status *

Faith/Religion *

Do you drink alcohol? *

What is your political affiliation?

Occupation *

Income *

Height (ft & in)

Do you smoke?

Preferred Gender *

Do you have children? *

Do you have any pet allergies? *

How did you hear about us? *

Activities/Hobbies I enjoy *

If friend, family or other, please tell us who referred you *

Describe your ideal partner *

Is there anything else you would like to share about yourself?

Please upload a recent headshot *

JPG, JPEG, PNG/10 MB max

Please upload a recent full-body image *

JPG, JPEG, PNG/10 MB max

**By submitting this form, I acknowledge and certify that the above information is accurate and true. I certify that I am legally unattached, a single male or female over the age of 18 years old, open to date coaching, and willing and able to enter a mutually agreed personal relationship. I agree to abide by the laws of the UAE, for any disputes to be presided over by the DIFC courts, and to the rules set forth and listed in the Privacy Policy and Terms & Conditions located on DubaiMatchmaker.com. I agree that any profiles or information sent to me by the Dubai Matchmaker team in person or electronically will be kept private and confidential which includes sharing details with acquaintances, contacting matches directly, or posting reviews on any social media or websites. I am clear that Open Memberships do not guarantee matches or introductions of any kind by the Dubai Matchmaker™ team. I understand that Eiléen Lee-Connor and the team at DubaiMatchmaker.com reserve the right to cancel all memberships or applications at any time, and for any reason. Lastly, I acknowledge and agree that all fees are non-refundable and non-transferable and that Dubai Matchmaker™ (license # 985698) reserves the right to add me to their confidential member database and mailing list for future events and partner offers.

I accept the Terms and Conditions