Phone Land Line:
PHYSICAL Mailing Address: (note) We cannot help you if you don't include your MAILING ADDRESS!
(must be good for at least 6 months) (Must include POSTAL CODE) PLEASE type or print carefully.
Qualities: and FB page:
Ideal Man: (age, race, etc)
Do you accept divorced man?
Do you accept man who smokes or drinks?
Do you want your photo to be published in our next magazine?
(if yes, please email us your best smiling color photo with a light background)
A swimsuit photo will get the most responses! Photo must be clear and in focus.
Have you been a member of our club before?
Where did you hear about our club?
← please leave this empty to show you are human
Please email us your photo at
Please tell all your friends about our website! We always need more ladies! Note: Please do not ask our clients to send you any money!
You can also print this form out and send to us by regular mail:
PO BOX 4601
Thousand Oaks CA 91359
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PACIFIC ISLAND LADIES