Match By Julia Sign Up Form

1 YEAR DATABASE MEMBERSHIP
A Database Membership allows us to create your profile and keep you active in the Database. When a paying client is looking for someone who fits your description and profile, we will contact you to see if you're interested in meeting him/her. This membership is good for a year. There are no guarantees with the Database Membership, and we can't specify a time frame or length of time of when we will contact you. By selecting this membership, you agree to these above set rules and understand that there are no guarantees to be made by Julia Bendis, and the team at Match by Julia.

3 AND 6 MONTHS UNLIMITED MATCHES MEMBERSHIP - varies
A 3 and 6 Month membership allows us to develop a close-knit relationship with each client. This gives us time to learn more about them without rushing into each date, and find quality matches for him/her. With this membership, you will receive unlimited matches within that time period.

DATING/RELATIONSHIP COACHING - $150 via phone, $200 in person
Whether you’re looking for help setting up your online dating profile, one coaching session before you set out into the dating world, or recurring sessions to feel comfortable getting back into it, we offer many different coaching packages. Fill out the Sign Up form below and we’ll find the right fit for you.
Please fill out the form below to start the process. After a thorough review, you'll receive an email with different membership options that you can choose from. We look forward to working with you!
Membership Information
Name *

First Name Last Name
Gender *
Phone *

Area Code Phone Number
Email Address *
Residence (City & State) *
How did you hear about us? *
Birthday *

Month Day Year Date Picker Icon
Where were you born and raised? *
Ethnicity *
Religion/Faith *
Political beliefs *
Height *
Weight *
Body type *

Thin Average Athletic Other
Would you be willing to relocate? *
Do you Own or Rent your home? *
Educational level *
College attended (Name and Degree) *
Employer Name *
Occupation/Position *
Income *
Do you smoke? *
Do you drink? How often? *
Do you do drugs (recreational or other)? *
Have you ever been in trouble with the law? (This will not disqualify you from our services) *
Do you have children? (If yes, ages) *
Do you want children? *
Do you have pets? (Dog, Cat, etc) *
If you were married, or in a long-term relationship tell us why it ended? *
Hobbies, activities, ways of staying in shape/being active *
3 Unique things about you (I won a Grammy, or I’m a gourmet cook) *
1
*
2
*
3
Tell us about yourself. This part is very important, and will be written in your profile for your matches to view (this portion will be on your profile for your potential matches to read, so please write in FULL sentences, check your spelling/grammar and take your time): *
What are you looking for in a PARTNER:
Ethnicity *
Religion *
Political Beliefs *
Age Range *
Gender *
Describe your ideal match (very important, don't leave it blank) *
Please attach at least 3 recent, different pictures of yourself. A full body and head shot (Do NOT attach selfies or pictures with other people, please crop them out. If you don't have good photos, these will only be used for our database, we won't share them with your potential matches, and will set you up with our photographer)
Resolution should be less than 4MB and in jpeg format.
Photo 1 *
Photo 2 *
Photo 3 *
Photo 4
I ACKNOWLEDGE AND CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT. BY SUBMITTING BELOW, I CERTIFY THAT I'M AN UN-ATTACHED, SINGLE MALE OR FEMALE WILLING AND ABLE TO BE MATCHED UP WITH A POTENTIAL PARTNER, AND ENTER INTO A POSSIBLE RELATIONSHIP IF BOTH PARTIES AGREE. I AGREE TO ABIDE BY ALL THE RULES SET BY MATCH BY JULIA AND JULIA BENDIS, AND AS LISTED IN THE TERMS AND CONDITIONS ON MATCHBYJULIA.COM. I AGREE AND CERTIFY THAT I WILL DO MY DUE DILIGENCE IN KEEPING ALL PROFILES SENT TO ME BY MATCH BY JULIA AND JULIA BENDIS PRIVATE AND CONFIDENTIAL. I CERTIFY THAT I WILL NOT SHARE PRIVATE PROFILES WITH ANYONE NOR WILL I LOOK UP THOSE INDIVIDUALS ON MY OWN, ON ANY SOCIAL MEDIA OR OTHERWISE. I ACKNOWLEDGE AND AGREE THAT ALL MEMBERSHIP FEES ARE NON-REFUNDABLE. IF I ENTER INTO A DATABASE MEMBERSHIP ONLY, THERE ARE NO GUARANTEES ON THE TIME FRAME OF POTENTIAL MATCHES FOR ME, NOR THE QUANTITY OF MATCHES. I ALSO ACKNOWLEDGE THAT BY AGREEING TO THIS CONTRACT, I WILL KEEP ALL CORRESPONDENCE BETWEEN JULIA BENDIS, AND MATCH BY JULIA TEAM PRIVATE AND CONFIDENTIAL; I AGREE NOT TO POST ANY PRIVATE EMAILS ONLINE OR ON ANY SOCIAL MEDIA, AND I WILL NOT POST ANY NEGATIVE REVIEWS ON YELP, GOOGLE OR ON ANY OTHER SOCIAL MEDIA OR WEBSITE. I AGREE TO FIRST COMMUNICATE WITH JULIA BENDIS AND THE MATCH BY JULIA TEAM.
Should be Empty:

What are you looking for in a PARTNER:

Resolution should be less than 4MB and in jpeg format.