CHAZAQ.org » Shidduch Service: "f you would like to be included in this service please fill out the following form. Your photo will not be shown to anyone other than the Shadchanim. If we feel that there may be a 'match', then you will be contacted immediately.
* First Name:
* Last Name:
* Address:
* City:
* State:
* ZIP:
* Home Phone:
* Cell Phone:
* E-Mail:
* Age:
* Date of Birth:
* Your Height:
What is the age range you prefer to date? -
What is your Marital Status? Never Married
Divorced
Other (Please explain)
If divorced, give the following Information:
Do you have Children? Yes No
If yes, How many?
Which Rabbi facilitated the Divorce?
Rabbi's Telephone Number "
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Monday, October 10, 2011
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