Answering this survey will allow us to begin connecting with you. Your personal information and answers are confidential and will not be shared under any circumstances.

The information you provide will only be used to support you and create a fabulous experience for you inside of Samba.

Thank you so much for sharing with us.

Name

First Name

Last Name

Email Address

Phone (In Case We Need To Speak To You Personally)

Country

(###)

###

####

Address (We Send Gifts!)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthday (We Love To Celebrate You!)

MM

DD

YYYY

What Do You Like To Do For Fun?

What Makes You Laugh?

Do You Have Children?

If Yes, How Many?

Would You Say You Have A Good Relationship With Yourself?

What Do You See As Your Biggest Hurdle When It Comes To Relationships That You Can't Get Past?

If You Could Create Anything You Wanted In Your Next Relationship, What Would It Be?

Anything Additional You Would Like To Share So We Can Provide You The Best Support Possible?