Transpacific Marriage Agency Personal Profile Form

Notice: If there's anything in your background that might make you unsuitable as a marriage partner, you must disclose that information after this question:

Is there anything about you which your future spouse would want to know before becoming involved with you?  Yes  No
If yes, please explain (attach extra sheets if necessary):

Please note that U.S. law requires U.S. clients to print out and send TMA this disclosure form.
 

For quickest service, please mail this completed form, along with a good photo and signed Agency Agreement to:

TMA
P.O. Box 706
Bayside, CA 95524-0706
U.S.A.

Registration Form for Men in Japan

Please check the Membership Option of your choice:

Sign up by Monday, Jan 20 and get a
20% discount on any membership!

Silver Membership - 3 months for ¥36,000 - 20% = ¥28,800

Gold Membership - 6 months for ¥54,000 - 20% = ¥43,200

Diamond Membership - 1 year for ¥72,000 - 20% = ¥57,600

(Click here for details about quarterly installment charges for Gold & Diamond memberships.)

You may specify an age range of at least 10 years for the woman you seek:

From (minimum) ________ up to (maximum) ________ years of age.

Please indicate how you prefer to receive your monthly profile mailings:

By postal mail
 By email

PAYMENT METHODS:

Visa
MasterCard
American Express
Discover

My credit card number is:

____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____

Expiration Date (month/year): ______ / ______

Name on Card: ____________________________________________________

Today's Date: ____________________________

Signature: ____________________________________________________

Credit card billing statements will show charges credited to "Transpacific Marriage."

Free Bonus Offers for Newly Registering Clients

Sign up now and receive these free services! Just check each service which interests you:

  I request that TMA send my profile and contact information to the women listed below and ask them to contact me if they are interested. Here are my choices:

Name: ________________________   Client number: _________________________
Name: ________________________   Client number: _________________________
Name: ________________________   Client number: _________________________
Name: ________________________   Client number: _________________________
Name: ________________________   Client number: _________________________
Name: ________________________   Client number: _________________________
Name: ________________________   Client number: _________________________
Name: ________________________   Client number: _________________________

  I would like TMA to scan my photo and send it to me by Email.

  I would like my photo and personal profile sent as a sample profile to all Japanese women who inquire to TMA and be notified of any women who request to contact me as a result (acceptance subject to approval by TMA).

  I would like to have my photo and profile posted on the TMA website for public viewing and be notified of any women who request to contact me as a result (acceptance subject to approval by TMA).

  I would like to add my email address to the TMA mailing list and be notified when new women's profiles are posted on the TMA site.

  I would like to be sent information about how I can place free personal ads in 7 publications widely read by Japanese women.

  I would like to have a free membership in an online dating club with many Japanese women members.

Declaration of Eligibility for Marriage

I, (print name), ___________________________________________ hereby certify and attest, under penalty of perjury and false statement, that I am at least 18 years of age and NOT MARRIED.  Furthermore, I understand that my participation in TMA's services is subject to the terms of the Transpacific Marriage Agency Agreement.

Transpacific Marriage Agency Agreement

• You must use the Service in a manner consistent with any and all applicable laws and regulations. You understand and agree that TMA may monitor, review, and delete any content, including, but not limited to, messages, photos, videos, profiles, text, graphics, and written or oral communications (collectively, "Content") which does or may, in the sole judgment of TMA, violate the terms of this Agreement or which might be considered offensive or illegal and/or that might violate the rights or otherwise harm, or threaten the safety of Members.
• You are solely responsible for the Content that you publish or display (hereinafter, "post") on the Service, or send to other Members.
• By asking TMA to post Content to any public area of the TMA Website, you automatically grant, and you represent and warrant that you have the right to grant to TMA irrevocable, perpetual, fully paid, worldwide permission to use, copy, perform, display, and distribute such information and content on the TMA Website.
• The following is a partial and non-exhaustive list of the kind and type of Content that is illegal or prohibited on the Website, in Members' Personal Profiles and in communications between Members. TMA reserves the right to investigate and take appropriate legal action in its sole discretion against anyone who violates this provision, including without limitation, removing the offending communication from the Service and terminating the membership of such violators. It includes Content that:
  • "stalk" or otherwise harass any person;
  • is unlawful, harmful, threatening, abusive, harassing, tortuous, defamatory, vulgar, obscene, libelous, invasive of another's privacy, hateful or racially, ethnically or otherwise objectionable;
  • promotes information that you know is false, misleading or promotes illegal activities or conduct that is abusive, threatening, obscene, defamatory or libelous;
  • promotes an illegal or unauthorized copy of another person's copyrighted work, such as providing pirated computer programs or links to them, providing information to circumvent manufacture-installed copy-protect devices, or providing pirated music or links to pirated music files;
  • contains software viruses or any other computer code, files or programs designed to interrupt, destroy or limit the functionality of any computer software or hardware or telecommunication equipment;
  • contains restricted or password only access pages, or hidden pages or images (those not linked to or from another accessible page);
  • solicits passwords or personal identifying information for commercial or unlawful purposes from other users;
  • involves the transmission of "junk mail", "chain letters," or unsolicited mass mailing or "spamming";
  • displays pornographic or sexually explicit material of any kind;
  • provides material that exploits people under the age of 18 in a sexual or violent manner, or solicits personal information from anyone under 18, or harm minors in any way;
  • provides instructional information about illegal activities such as making or buying illegal weapons, violating someone's privacy, or providing or creating computer viruses; and
  • engages in commercial activities and/or sales without our prior written consent such as contests, sweepstakes, barter, advertising, and pyramid schemes;
• You may not include in your Member profile any telephone numbers, street addresses, last names, URL's or email addresses.
• You may not engage in advertising to, or solicitation of, other Members to buy or sell any products or services through the Service. You may not send any chain letters or junk email to other Members. Although TMA cannot monitor the conduct of its Members, it is also a violation of these rules to use any information obtained from the Service in order to harass, abuse, or harm another person, or in order to contact, advertise to, solicit, or sell to any Member without their prior explicit consent.

© Transpacific Marriage Agency (TMA)