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Member Information
* Please fill all the fields.
Basic Information
First Name:
Email Address:
Phone:
Last Name:
Mobile:
Username:
City:
Gender:
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Male
Female
Password:
State:
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Tennessee
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Frame :
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Thin
Average
Medium
Above average
Confirm Password:
Country
USA
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Spain
Sweden
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Venezuela
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Fathers Name:
Mothers Name :
Date of Birth:
Are you a Cohen? :
-- Select --
Yes
No
Parents Information
Are your parents divorced?
Select
Yes
No
If yes how many years?
Is either one remarried?
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Yes
No
N/A
Are you a convert?
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Yes
No
Is your father a convert?
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Yes
No
Is your mother a convert?
Select
Yes
No
Country/City where parents were raised:
Education & Occupation Information
My education level:
Select
High School
Some College
Bachelors
Master
MD or PHD
Name of High School
Name of College:
Degree obtained:
What is your profession?
Name of Yeshiva/Seminary
what language do you speak?
Marital Information
Marital Status:
Select
Single
Separated
Divorced
Widow
If divorced: Did you receive/give a get?
Select
Yes
No
N/A
Do you have kids:
Select
Yes
No
How many kids:
How old are they?
Do they live with you?
Do you want more kids?
Physical Information
Are you a smoker?
Select
Yes
No
How would you describe your personality?
Select
Outgoing
Reserved/Somewhat shy
Very shy & quiet
High energy
Serious
Fun
Funny
Other
If other,Describe your personality
How many siblings do you have?
Are any of your siblings married?
Select
Yes
No
N/A
To whom they are married?
Contact Number
Do you have any disabilities?
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Yes
No
If yes, please describe in detail
Are you physically active?
Select
Yes
somewhat
rarely
What age range are you looking for?
From:
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18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
To
Select
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
Height:
Select
4'0
4'1
4'2
4'3
4'4
4'5
4'6
4'7
4'8
4'9
4'10
4'11
4'12
5'0
5'1
5'2
5'3
5'4
5'5
5'6
5'7
5'8
5'9
5'10
5'11
5'12
6'0
6'1
6'2
6'3
6'4
6'5
6'6
6'7
6'8
6'9
6'10
6'11
6'12
What height range would you accept?
From
Select
4'0
4'1
4'2
4'3
4'4
4'5
4'6
4'7
4'8
4'9
4'10
4'11
4'12
5'0
5'1
5'2
5'3
5'4
5'5
5'6
5'7
5'8
5'9
5'10
5'11
5'12
6'0
6'1
6'2
6'3
6'4
6'5
6'6
6'7
6'8
6'9
6'10
6'11
6'12
To
Select
4'0
4'1
4'2
4'3
4'4
4'5
4'6
4'7
4'8
4'9
4'10
4'11
4'12
5'0
5'1
5'2
5'3
5'4
5'5
5'6
5'7
5'8
5'9
5'10
5'11
5'12
6'0
6'1
6'2
6'3
6'4
6'5
6'6
6'7
6'8
6'9
6'10
6'11
6'12
Describe in one paragraph, your personality and what you are looking for:
Other Information
The country/city I grew up in:
I am of the follow descent:
Select
Ashkenazi
Persian
Iraqi
Bucharian
Russian
Syrian
Afgani
Other Sephardic
Are you a baal teshuva?
Select
Yes
No
The name of the synagogue that you are affiliated with
Of how many years?
The name of the rabbi that you are affiliated with
Would you consider a baal teshuva?
Select
Yes
No
Which marital status would you consider?
(You can select more than one answer)
Single only
Divorced/No kids
Divorced/with kids
Widow
All
Are you willing to relocate?
Select
Yes definitely
No definitely not
Maybe
Where would you consider relocating?
Current Religious Status:
Select
Orthodox
Modern Orthodox
Conservative
Reformed
Traditional
(Boys) Do you wear a kippa?
Select
Yes
No
Maybe
N/A
(Girls) Do you wear
Select
Skirts only
Pants
Skirts and Pants
N/A
(Boys) Do you want your wife to cover her hair?
Select
Yes
No
Maybe
N/A
(Girls) Do you want to cover your hair?
Select
Yes
No
Maybe
N/A
Do you want a TV in your house?
Select
Yes
No
Maybe
Do you want to go to the movies?
Select
Yes
No
Maybe
How often do you pray?
How often do you learn?
What is your current level of observance of Kashrut?
(You can select more than one answer)
Kosher in the house
Kosher outside of the house
Eat dairy in non-kosher places
Machmir
What is your level of observance of Shabbat?
Select
Completely shomer Shabbat
Traditional Shomer Shabbat
No Shabbat observance
What are you looking for religiously in a match?
(You can select more than one answer)
Definite Head covering
Half day learning/half day working
Full day learning (Kollel)
Full-time working/ Dedicated Learning
No shabbat
No head covering
Shabbat only
Upload picture
(Please upload pictures below 1MB)
Upload picture
(Please upload pictures below 1MB)
As a courtesy to the Rabbi Matchmakers please provide modest pictures only
Are we allowed to show your picture to a possible match?
Select
Yes
No
Are we allowed to share your profile with all the matchmakers on the site?
Select
Yes
No
RABBI ALON (New York)
kamelia arastehmanesh (new york)
Miriam Cohen (NY)
Nagila Gholian (New York)
S Gol (New York )
Sarah Kohan (New York)
Farah Lavian (NY)
We will provide the male with the profile first unless otherwise noted by you
Select
Yes, Male first
No, Female first
Do you want the matchmaker to set up the date?
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Yes
No
References Information
Name
Contact Number
Relation
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