Speed Dating pre-registration form
Let the flirting begin.
What would you like to be referred to as?
*
First Name
Nickname
Birth date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
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29
30
31
Day
Please select a year
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
Year
Gender
*
Male
Female
Current Status
*
Single
Dating
Situationship
Occupation
*
E-mail
*
Boro you live in
Please Select
Queens
Brooklyn
Bronx
Manhattan
Staten Island
Out of the Boro's
Phone number
-
Area Code
Phone Number
If interested in someone at this event, How would you like your match to contact you?
Phone
Email
Social media
All
Recent photo
*
Upload a File
Identity verification will be made by Mz Redbone
Cancel
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What is your sexual orientation?
Straight
Bisexual
Gay
Other
Have you ever attended a speed dating event?
Yes
No
Give a brief description of what you are looking for from this Speed Dating event?.
What outcome would you prefer after this event?
Looking for love
Just a SPRING FLING
Flirty friendship
Other
Submit
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