The "Mike needs a date" potential date application form


in partial fulfilment of the requirments of ICS 491 (forms w/ "mailto:")






Disclaimer: Mike really isn't this arrogant, I am under no illusions. However I think this is a pretty cool useof "forms" and hey, you can't blame a guy for trying.


Please answer all questions as completely and as accurately as possible, neatness counts, please show all work, no talking during the form-filling-in procedure, keep your eyes off your neighbors form, there will be no eating or drinking and no chewing gum during the form, please try to refrain form using the letter "Å" in your form, you may begin now. 

You are female correct? :You betcha!

Your name:            
Your e-mail:
(anon remailers okay) 
Your age:             
Where are you:        
Phone number:
(optional, but for fastest service...)
A brief description of your self please:

Things you like about Mike thus far Other information Mike Might like to know



Thanks a bunch




This page maintained and written by Mike
Last update 2/6/96
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