MEMBERSHIP ENQUIRY FORM

Your first step in becoming a member is to complete the form below.
Your local representative will contact you and explain everything.
If you require assistance completing this form : Phone 1300 885 311
A Table for Six guarantees confidentiality. Privacy Policy & Terms.

  CONTACT DETAILS - REQUIRED*
 
     
  First Name*

 

 
  Last Name*

 

 
  Email*

 

 
  Mobile*

 

 
  Postcode*

 

 
  Date of Birth*

 

 
  Gender*

  Male Female

 
  Platinum Introductions*

  Yes NO

 
  Best Contact Time*  

 
 
           
  OTHER DETAILS - Complete if you have the time now, otherwise
Type Agree at the bottom of this page and Submit the form.

 
  How You Heard of us

 

 
  Referring Member  

 
  Street Address

 

 
  Suburb or Town

 

 
  State

 

 
  Home Phone

 

 
  Work Phone

 

 
  Occupation

 

 
  Describe Yourself  

 
  Height

 

 
  Marital Status

 

 
  Children

  YES NO

 
  Smoker

  YES NO

 
  Drinker

  YES NO SOCIAL

 
  Your Interests   Adventure Activities

Art Galleries

Dining Out

Entertaining

Four Wheel Driving

Gym

Movies

Music Theatre

Personal Growth

Reading

Serious Exercise

Social Exercise

Sport

Travel

Weekends Away

Movies at Home

 
  Other Interests

 

 
  Your Traits   Affectionate

Ambitious

Confident

Family oriented

Generous

Genuine

Healthy lifestyle

Intelligent

Motivated

Outgoing

Positive attitude

Romantic

Serious

Shy at first

Very social

Warm

 
  Best Contact Method

 

 
  To get to know you better we would like you to upload a digital photo to include with your a Table for Six profile. It won't be distributed or posted on the web. We request photos for in-house purposes only. We do not share photos with other members. It must be less than 200kb and a gif or jpg file. If not it will fail to upload.
Please upload it now or you may email it to us at info@atableforsix.com.au

 
     


 
  PLATINUM INTRODUCTIONS SECTION

 
  If you are interested in Platinum Introductions our one on one specialised service,
please complete the extra fields below.

If you are not interested in our Platinum Service
Type Agree at the bottom of this page and Submit the form.


 
  Qualities you agree you possess and embrace when taking on Platinum Introductions   Active, Fit and Healthy

Confident, Not Arrogant

Emotionally Mature Caring Kind

Enjoy Giving-Supporting Others

Have a realistic view of my future

Mix Easily-Good Communicator

Not in a committed relationship

Open Minded Tolerant

Respectful and Accepting

Social Not Inappropriate Drinking

Well Groomed Clean Living

   
  The person you would like to meet at Platinum Introductions :

 
  Desired qualities in a partner  

 
  Essential qualities in a partner  


 
  Would you consider meeting someone who has dependant children ?

  YES NO

 
  If you met the right person, would you consider any/more children ?

  YES NO

 
  What is Your Build?

   
  Preferred Build in a Potential Partner

   
  Preferred Height in a Potential Partner

   
  Preferred Age in a Potential Partner

   
  Would you meet a potential partner outside of your city?

  YES NO

 
  Would you meet a potential partner outside of your state?

  YES NO

 
  Other particular Interests - Hobbies or Activities not already mentioned  

 
           
 

Yes - I Agree to the TERMS and I Agree to be contacted by A Table for Six
 
      *