Print this page and answer all question. Then send by regular mail to the address listed below or save this page to word pad and return by e-mail to the address listed below. All questions must be answered. Questions highlighted in red will not be posted on-line or given to other members ever. Information in red is for our records only and will remain private. Questions listed in black will be posted in your ad on-line. Print or type your answers..........
First Name:______________________Last Name:_________________________
Address:______________________________________________________
City:____________________________ State:_______________
Phone:____ - ____ - _____ Sex:____________ Age:_________ Race:_____________
Please write your ad below and keep it limited to 100 words or less.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Will you be sending a picture?_______ If so,
Will you be sending your picture by e-mail or US mail? ___________
State you would like your ad posted in?___________________
Your e-mail address__________________________________
I_______________________________________(print your full name) am requesting that ASN post
my ad on-line. I have read there rules for placing a free ad and agree to there policy's and
terms. I ascertain that I'm the person listed above and that I have signed my real signature
to this form. Signature:____________________________
Send information by regular mail to:
America's Singles Network
PO Box 2733
Middlesboro, KY 40965
CLICK HERE to return to ASN directory page or CLICK HERE to get a free e-mail account from Lycos!
