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<td background="images/600X400_01_03.jpg" WIDTH=354 HEIGHT=344><table width=340 cellspacing=0 cellpadding=3 border=0 align=CENTER height="181">
<tr height="23">
<td align=right width="132" height="23"><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;">Login Name </span></td>
<td height="23"><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;"><input type=TEXT name="LOGIN" size=15 maxlength=50 STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;"></span></td>
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<tr height="23">
<td align=right width="132" height="23"><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;">Password </span></td>
<td height="23"><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;"><input type=PASSWORD name="PASSWORD" size=15 maxlength=20 STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;"></span></td>
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<tr height="23">
<td align=right width="132" height="23"><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;">Confirm Password </span></td>
<td height="23"><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;"><input type=PASSWORD name="confirm" size=15 maxlength=20 STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;"></span></td>
</tr>
<tr height="23">
<td align=right width="132" height="23"><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;">Email </span></td>
<td height="23"><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;"><input type=TEXT name="EMAIL" size=15 maxlength=100 STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;"></span></td>
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<tr height="21">
<td align=right width="132" height="21"><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;">Country </span></td>
<td height="21"><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;"><select name="COUNTRY" STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;">
<option>Please Select</option>
<option selected>United States
<option>Canada
<option>Afghanistan
<option>Albania
<option>Algeria
<option>American Samoa
<option>Andorra
<option>Angola
<option>Anguilla
<option>Antartica
<option>Antigua
<option>Argentina
<option>Armenia
<option>Aruba
<option>Ascension Island
<option>Australia
<option>Austria
<option>Azerbaijan
<option>Bahamas
<option>Bahrain
<option>Bangladesh
<option>Barbados
<option>Belarus
<option>Belgium
<option>Belize
<option>Benin
<option>Bermuda
<option>Bhutan
<option>Bolivia
<option>Bosnia-Herzegovina
<option>Botswana
<option>Brazil
<option>British Virgin Islands
<option>Brunei
<option>Bulgaria
<option>Burkinoa Faso
<option>Burma
<option>Burundi
<option>Camaroon
<option>Cambodia
<option>Canada
<option>Cape Verde Islands
<option>Cayman Islands
<option>Central African Rep.
<option>Chad Republic
<option>Chile
<option>China
<option>Colombia
<option>Comoros
<option>Congo
<option>Cook Islands
<option>Costa Rica
<option>Croatia
<option>Cyprus
<option>Cuba
<option>Cyprus
<option>Czech Republic
<option>Denmark
<option>Diego Garcia
<option>Djibouti
<option>Dominica
<option>Dominican Republic
<option>East Timor
<option>Ecuador
<option>Egypt
<option>El Salvador
<option>Eqitorial Guinea
<option>Eritrea
<option>Estonia
<option>Ethiopia
<option>Faeroe Islands
<option>Falkland Islands
<option>Fiji Islands
<option>Finland
<option>France
<option>French Guiana
<option>French Polynesia
<option>French Antilles
<option>Gabon
<option>Gambia
<option>Georgia
<option>Germany
<option>Ghana
<option>Gibraltar
<option>Greece
<option>Greenland
<option>Grenada
<option>Guadeloupe
<option>Guam
<option>Guantanemo Bay
<option>Guatemala
<option>Guinea
<option>Guinea Bissau
<option>Guyana
<option>Haiti
<option>Honduras
<option>Hungary
<option>Iceland
<option>India
<option>Indonesia
<option>Iran
<option>Iraq
<option>Ireland
<option>Israel
<option>Italy
<option>Ivory Coast
<option>Jamaica
<option>Japan
<option>Jordan
<option>Kazakhstan
<option>Kenya
<option>Kiribati
<option>Korea, North
<option>Korea, South
<option>Kuwait
<option>Kyrgyzstan
<option>Laos
<option>Latvia
<option>Lebanon
<option>Lesotho
<option>Liberia
<option>Liechtenstein
<option>Lithuania
<option>Luxembourg
<option>Macedonia
<option>Madagascar
<option>Malaysia
<option>Malawi
<option>Maldives
<option>Mali Republic
<option>Malta
<option>Marshall Islands
<option>Mauritania
<option>Mauritius
<option>Mexico
<option>Micronesia
<option>Moldiva (CIS)
<option>Monaco
<option>Mongolia
<option>Montserrat
<option>Morocco
<option>Mozambique
<option>Namibia
<option>Nauru
<option>Nepal
<option>Netherland Antilles
<option>Netherlands
<option>Nevis
<option>New Calidonia
<option>New Zealand
<option>Nicaragua
<option>Niger
<option>Nigeria
<option>Niue Island
<option>Norfork Island
<option>Norway
<option>Oman
<option>Pakistan
<option>Palau
<option>Panama
<option>Papua New Guinia
<option>Paraguay
<option>Peru
<option>Philippines
<option>Poland
<option>Portugal
<option>Qatar
<option>Reunion Island
<option>Romania
<option>Russia
<option>Rwanda
<option>Saipan
<option>Sao Tome
<option>Saint Lucia
<option>Samoa
<option>San Marino
<option>Saudi Arabia
<option>Senegal
<option>Seychelles Island
<option>Sierrra Leone
<option>Singapore
<option>Slovakia
<option>Slovenia
<option>Soloman Island
<option>Somalia
<option>South Africa
<option>Spain
<option>Sri Lanka
<option>St Helen
<option>St Kitts
<option>St Lucia
<option>St Pierre
<option>St Vincent
<option>Sudan
<option>Suriname
<option>Swaziland
<option>Sweden
<option>Switzerland
<option>Syria
<option>Taiwan
<option>Tajikistan
<option>Tanzania
<option>Thailand
<option>Togo
<option>Tonga
<option>Trinidad & Tobago
<option>Tunisia
<option>Turkey
<option>Turks/Caicos
<option>Turkmenistan
<option>Tuvalu
<option>Uganda
<option>Ukraine
<option>United Arab Emirates
<option>United Kingdom
<option>United States
<option>Uruguay
<option>Uzbekistan
<option>Vanuatu
<option>Venezuela
<option>Vietnam
<option>Virgin Islands
<option>Wallis / Futuna
<option>West Samoa
<option>Yemen
<option>Yugoslavia
<option>Zaire
<option>Zambia
<option>Zimbabwe</select></span></td>
</tr>
<tr height="23">
<td align=right width="132" height="23"><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;">Zip Code </span></td>
<td height="23"><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;"><input type=TEXT name="ZIP" size=15 maxlength=10 STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;"></span></td>
</tr>
<tr height="20">
<td align=right width="132" height="20"><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;">I am a </span></td>
<td valign=TOP height="20"><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;">Male <input type=RADIO name="GENDER" value=male align=absbottom style="background-color : #da8289;"> Female<input type=RADIO name="GENDER" value=female checked align=right style="background-color : #da8289;"><br></span></td>
</tr>
<tr height="20">
<td align=right width="132" height="20"><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;">Seeking a </span></td>
<td valign=TOP height="20"><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;">Male <input type=RADIO name="MATCH_TARGET_DETAILS" value=20101 checked align=middle style="background-color : #da8289;"> Female<input type=RADIO name="MATCH_TARGET_DETAILS" value=20102 align=middle style="background-color : #da8289;"><br></span></td>
</tr>
<tr>
<td align=right WIDTH=132><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;">Dating Preference </span></td>
<td><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;"><select name="PERSONAL_DETAILS" STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;">
<option selected value=0>Choose one</option>
<option value=101>Dating</option>
<option value=102>Friendship</option>
<option value=103>Relationship</option>
<option value=104>Marriage</option>
<option value=105>Marriage and Children</option>
<option value=106>Intimate Encounters</option>
</select><br></span>
</td>
</tr>
<tr>
<td align=right WIDTH=132><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;"> </span></td>
<td><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;"><BR><INPUT TYPE=SUBMIT VALUE="Continue" BORDER=0></span></td>
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<td><SPAN STYLE="font-family: Verdana, Arial, sans-serif; font-size: 11px;"> I affirm that I am at least 18 years of age and that I agree to the One2Onematch <a href="http://www.one2onematch.com/terms.html" onclick="window.open('http://www.one2onematch.com/terms.html','Terms','toolbar=no,location=no,directories=no,status=no,menubar=no,resizable=yes,copyhistory=no,scrollbars=yes,width=615,height=460,top=5,left=5');return false;" STYLE="color: #98000d; text-decoration: underline;">Terms of Use</a> and <a href="http://www.one2onematch.com/privacy.html" onclick="window.open('http://www.one2onematch.com/privacy.html','Privacy','toolbar=no,location=no,directories=no,status=no,menubar=no,resizable=yes,copyhistory=no,scrollbars=yes,width=615,height=460,top=5,left=5');return false;" STYLE="color: #98000d; text-decoration: underline;">Privacy Policy</a></span></td>
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