Featuring Event Updates and
Information for Singles!

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(Please use send button at bottom to e-mail us the completed form)

PBSN V.I.P. E-mail Registry

Hello - We periodically send e-mail about special events and programs sponsored by PBSN. If you wish to receive our updates, please complete the following.

Name:

Address:

City/Town:

State:

Zip Code:

County:

email:

area code & home phone number:

Single Status:

Date of Birth: ex: 10-15-1955

Sex:

Highest degree earned:

Occupation:

Position /Title:

Do you like to entertain?:

Check services of interest to you:

 

Would you consider:

· being on committee and helping at events?   Yes   No

· hosting a social at your home/business?    Yes   No

· being a discussion moderator / facilitator?   Yes   No

 

How did you hear about PBSN ?

 

   

Click on Send button only once.... Then Send Mail.

Thank you for requesting more information or updates.