Please print this form, answer a question, affix your photo, and send it by air mail.
1. Nickname
2. Age
3. Height
4. Weight
5. Occupation
6. Present city (City name)
7. E-mail address
8. Telephone No
9. Are you single?
10. What kind of man do you like? ( Age )
11.Can you speak read or write Japanese?
Address
Hatakeyama Nobuyuki
3-11-1-1105 Hikonari Misatoshi Saitama 341-0003 Japan