Profile

First Name*	MI	Last Name*
Primary Email*	Secondary Email
Address*
City*	State*	Zip*
Phone*	Fax
Work City	Work State
Age Group*	Gender*
Marital Status*	Do You have any Children?*

In 10 words or less, describe your occupation.	In 10 words or less, describe your personality.
How long have you lived and/or worked in the Chicago area?*	What is your main motivation for wanting a customized Get A Life! In the City: Chicago Plan?*
Arts & Crafts Classes and Organizations Please select from the following: Calligraphy Ceramics Drawing Furniture Making Gardening Graphic Arts Interior Decorating Jewelry Making Painting(Oil,Watercolors,etc) Photography Sculpting Web Design Other	If you selected Other or if you have something specific in mind within the activities you selected, please use the space below to provide us with additional information.
Acting, Theatre, & Film Classes and Organizations Please select from the following: Acting-On Camera Acting-Theatre Circus Arts Comedy/Improv Comedy Writing Film Production Playwriting Public Speaking Modeling Screenwriting Voice Training Video Production Other	If you selected Other or if you have something specific in mind within the activities you selected, please use the space below to provide us with additional information.
Food & Wine Classes and Organizations Please select from the following: Appetizers Baking Breakfasts Cooking Tours-Local Cooking Tours-National Cooking Tours-International Demonstrations Desserts Dinners/Entrees Ethnic Cooking Knife Skills Meats Pasta Soups Vegetarian Cooking Wine Tastings Wine Classes Other	If you selected Other or if you have something specific in mind within the activities you selected, please use the space below to provide us with additional information.
Dance Classes & Organizations Please select from the following: Ballet Belly Dance Salsa Merenge Jazz Hip-Hop Flamenco Tap Tango Pilates Yoga Other	If you selected Other or if you have something specific in mind within the activities you selected, please use the space below to provide us with additional information.
Foreign Languages & Culture Please select the language(s) you would like to learn: Arabic Chinese French Japanese Italian Spanish German Other	If you selected Other or if you have something specific in mind within the activities you selected, please use the space below to provide us with additional information.
Writing Classes Business Writing Creative Writing Fiction Non-Fiction Novel Writing Songwriting Other	If you selected Other or if you have something specific in mind within the activities you selected, please use the space below to provide us with additional information.
Music Classes Banjo Bass Clarinet Fiddle Flute Guitar Harmonica Harp Mandolin Musical Reading Percussion Piano Trumpet Ukulele Violin Vocal Training Other-Instruments Genre-Blues Genre-Jazz Other-Genre Other-Music	If you selected Other or if you have something specific in mind within the activities you selected, please use the space below to provide us with additional information.
Adult Continuing Education, Personal Growth, and Other Classes Please use the space below to indictate any other type of class you're interesed in that was not listed.
Sports & Fitness Please select from the follwowing types of Sports and Fitness activities. Basketball Biking Bowling Canoeing Flag Football Floor Hockey Golf Ice Skating Karate Kayaking Marathon Training Pilates Rowing Running Sailing Skiing/Snowboarding Speedskating Soccer Softball Swimming Tai Chi Tennis Triathlon Training Volleyball Walking Yoga Other	If you selected Other or if you have something specific in mind within the activities you selected, please use the space below to provide us with additional information.
Socializing & Networking Please select from the follwowing categories of social and networking activities. Then use the space below to specify the types of organizations or events that interest you. Dining Clubs Social Clubs Fundraisers/Galas Professional Organizations Seminars/Conferences Singles Organizations Singles Events Socials/Parties/Events Other	Please provide specific details regarding the type of professional or social organization or events you are interested in.
Volunteer Work Please select from the following categories. Also, in the space below, please indicate how you'd enjoy making a difference within a charitable organization. Adult Literacy Animal Protection & Welfare Children & Young Adults Employment/Job Training Environment & Beautification Financial Counseling Fundraising Homelessness & Hunger Housing & Community Development Immigrants Museums & Cultural Centers Senior Citizens Women's Services Other	Please indicate how you'd enjoy making a difference within a charitable organization.

Get A Life! In the City � Communications & Publications, Inc.

Thank-you for choosing to complete a profile for your very own Get A Life! In the City �: Chicago Action Plan for a small, one time investment of $29.95. Based on your interests, we will find organizations in the Chicagoland area for you to further investigate. For example, if you enjoy skiing, biking, dancing, and painting, we�ll find ski clubs, biking clubs, dance studios, and painting classes. Your customized Get A Life! In the City �: Chicago Action Plan will provide contact information and a brief description about each organization. It�s then up to you to get more information on how you can participate in any programs and activities they offer. It is also your responsibility to ensure that the organizations meet your needs before making any financial decisions. Please be advised that Get A Life! In the City Communications and Publications, Inc., is not an affiliated agent of the various businesses and/or service providers that may be included in your individual 'Get A Life! In the City Action Plan'. As such, Get A Life! In the City Communications and Publications Inc. disclaims any warranties or guarantees, express or implied, regarding the quality of any product or service offered by a listed business or service provider. You must be at least 18 years or older to order a customized plan. We respect your privacy. Please be advised that any information provided to Get A Life! In the City Communications and Publications, Inc. will only be used for purposes of creating your personalized plan and maintaining internal business records. In no case will any personal information be assigned to or exchanged with a third party.

Get A Life! In the City