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Step 1: Personal Information

Welcome to the Concerned Singles Membership Application Form.
If you prefer to mail your application, click here for a  form, print it, and mail the completed form, with your payment, to:
Concerned Singles, Box 444, Lenox Dale, MA 01242
We have made this form as easy as possible to use, but if you have a question about a particular item, click the () Help button associated with that item.
You may use this form to join for the first time or to renew your membership. If you are submitting a revised listing, or are simply opening or adding to your email forwarding account, Contact Us.
First Name (required)  Initial 
Last Name (required)
Email (required)
Address Line 1 (required)
Address Line 2
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Zip/Postal Code (required)
Country (required)
Phone (required) ()
 Home  Work  Cell
Please select your partner:
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Discover why so many people are telling us "CS, I Love You!"

quality of the people...something wonderful...deeply held values...appreciate all the details...appreciate all you do...unique and special...above and beyond the call...you guys are fast...specifically progressive focus...refreshingly unbureaucratic...not the least bit corporate...speedy response...a pleasure to deal with you...none quite like yours...great service...unlike any I've previously seen...very satisfied...deal with an actual human being...progressive individuals...a brilliant idea...excellent, caring service...you are awesome...the most interesting women...thanks for being...personal consideration...

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