Connection Counter by Mindful MatchUp
Tell us who you connected with and if you match, we'll help you two see each other again!
Your Full Name
*
First Name
Last Name
Your Email
*
example@example.com
Connection Circumstances
*
Please Select
At Dating IRL event
At another socially planned event
At a family/friend's party
At a work event
Random meeting in a public space
Date Connection Was Made
*
-
Month
-
Day
Year
Date
Address Connection Was Made At
*
Street Address
Street Address (ex: 123 Main St.) or Location Name (ex: YMCA)
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Do you know the name of the person you connected with?
*
Yes
No
Name of Person You Connected With (first, last, or both are helpful)
First Name
Last Name
What are some ways to describe them? What were they wearing, what did they look like?
This will help us figure out who you connected with if you don't remember their name! =)
What were you wearing when you met this person? What do you look like? (This is in case they describe you!)
What are the top 2 qualities of theirs that you are drawn to?
Demeanor (i.e. positive, calm, fun)
Energy (i.e. adventurous, playful, ambitious, funny)
Emotional Intelligence (i.e. empathetic, accountable, connected)
Values (i.e. kind, generous, honest)
Personality (i.e. confident, good conversationalist, reciprocal)
Gifts (i.e. physically attractive, intelligent, successful)
Other
Want to share a statement/compliment about who you met?
Example: "John was a good listener and made me laugh!"
Anything else you'd like to tell us about this connection?
We're excited to help you build authentic connections and relationships!
Look for a confirmation email with the next steps! Hope to see you soon!
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