This seems simple enough.

Name @ LJ/DW: (if applicable)
Name/Handle:
Age/Location:
Fandoms (if applicable):
What interests me:
What does NOT interest me:
Major Hobbies:
My LJ/DW Contains Mostly:
Other: (If you want to link pictures or something, do it here)

*note: I grabbed this from one of the fandomsecrets friending memes (as it was the first one that came to mind) and modified some to fit what I felt would best suit things here.