Join now | Pacific Relations

Exclusive matchmaking service for successful busy professionals

We want you to experience our "1 month" FREE Gold Memberhip! In order to qualify yourself as a FREE membership, your background check must be done through Liebe Romance. If you use incorrect information, such as incorrect name, incorrect address and birth date, Liebe Romance will not offer you FREE membership. Please read each question carefully. Take your time to think about yourself and fill out this form. Liebe Romance trusts each applicant's honesty so that all the members can meet safely. When Liebe Romance finds out that information you gave is false, or misleading to other members, Liebe Romance has a right to cancel your membership any time without notice. Liebe Romance keeps your information confidential and will never sell your information to others.
Contact Information
First name
Middle name
Last name
DOB (Date of Birth)
Address - Street, Apt#
City
State/Provice/Prefecture
Zip/Postal Code	Country
Phone (Day)
Phone (Evening)
Primary E-mail address (email which Pacific Relations can reach any time. This is the primary contact source)
Secondary E-mail address (email address you want to give to the women)
How did you find Liebe Romance?
If through Agent, Agent's name
Your Personal Data
What is your nationality?
What is your ethnic background?
What's your height?
What's your weight?
Your eye color / Hair color	/
What level of education have you completed?
What is your marital status?
Do you have any children?	Yes No
If "Yes", Please state the condition. ( Ex: son is 2, and daughter is 4, both living with their mother)
What is your religion?
What is your occupation and job title?
What is your approximate annual Income?
Do you speak other language?	Japanese Korean Chinese Spanish French Other
How often do you smoke?
How often do you drink?
Do you want children in future?	Yes No Undecided
Are you interested in living overseas? (Are you willing to move to your partner's country?)	Very Interested (2 years or more) Interested (2 years or less) Slightly Interested (Travel often) Very Slightly Interested (Travel sometimes) Not Interested
My Request Match
What's the age range of your Match?	Between: and
What's the education level of your Match?
What's the marital status of your Match? (Select as many as you like)	No Preference Single (never married) Divorced Widowed
Does your Match have a child?	Rather not does not matter
What's the minimum annual income for your Match?
Does your Match smoke?
Does your Match drink?
Would your friends consider you an outgoing person?
	Yes No
Would your friends consider you a spontaneous person?
	Yes No
Do you consider yourself athletic?	Yes No
Do you like sporting events?	Yes No
Do you like to go to clubs and dancing?	Yes No
Do you like to go to the movies?	Yes No
Do you enjoy a quiet evening at home?	Yes No
Do you enjoy outdoor activities?	Yes No

Tell us about you. Your likes and dislikes, your hobbies and activities.

Important Questions
Are you physically and mentally healthy enough to conduct a normal marriage life?
	Yes No
Do you have any sexual transmitted diseases (Examples are AIDS, Herpes, etc...)?
	Yes No
Within the past 5 years, have you been arrested, entered a plea of guilty or been convicted of a misdemeanor or felony offense against criminal, civil, military law, or been released from a prison, or detention facility, or are you now under charges for any offense against the law?
	Yes No
Please read the following before you submit the form.
(1) You must be single and marriage-minded. (2) You must be 21 years old or older. (3) You must respect the privacy of the other Lieberomance clients. (4) You must not take illegal drugs. (5) You must not be involved in any illegal activities. (6) You cannot have any criminal record for the last 5 years. (7) All clients affirm that they are in sound physical and mental health and are able to conduct a normal social and marital life. (8) All clients are required to register a personal profile with at least one good photograph. (9) Pacific Relations reserves the right to edit any personal profile to protect clients' privacy and provide the most current information of our clients to our other clients. (10) All documents submitted to Lieberomance shall contain nothing but the truth and all photographs submitted to Lieberomance shall be accurate representations of the client. (11) Lieberomance may refuse service or terminate service to people that we determine are displaying an uncooperative or hostile attitude. (12) Lieberomance pledges to take reasonable care in all its duties, and all clients agree to hold Lieberomance harmless for inadvertent errors by Lieberomance and misdeeds by other clients. (13) In the unlikely event that legal disputes of any kind should arise between Lieberomance and a client or clients, all parties agree to submit the dispute to a mutually agreeable, neutral third party for mediation and settlement. (14) All documents and photographs submitted to Lieberomance become the property of Lieberomance . (15) All clients grant Lieberomance rights to distribute their profiles and photos. (16) All clients agree that all the profiles and photos they receive may not be copied, redistributed or resold. (17) Lieberomance reserves the ritht to distribute the profiles and photos for a minimum of one year unless requested by the client to stop. (18) Fees are non-refundable. (19) Lieberomance will do what it can to help clients find compatible mates, but Lieberomance cannot guarantee results. (20) Success fee must be paid within 30 days after you are legally married. Failure to do so may cause Lieberomance to take some legal actions. (21) Lieberomance can assume no liability for what happens between clients. The individual clients themselves are responsible for their own behavior. (22) Clients shall notify Lieberomance upon becoming engaged or married so that Lieberomance can cease distributing their profiles and photos. (23) Client authroizes Info Cubic to conduct a background check on him/herself.
I swear that my contact information and my personal data given to Pacific Relations are all true and I comply with Pacific Relations Policy on Introductions. I understand Pacific Relations does not and will not guarantee to find my future partner.
I agree I disagree

Pacific Relations 2001 - 2007, Division of Liebe Romance, Co., Ltd.
Pacific Relations is a exclusive matchmaking company for Western gentlemen and Japanese ladies

Exclusive matchmaking service for successful busy professionals