Dating Form
Speed dating/Single Mixer Orl, FL.
Name
First Name
Social Media Handle Name:
Date of Birth
-
Month
-
Day
Year
Date
Are you single ? Looking for a man or woman?
Yes I am single
No I am not single but it’s complicated.
Looking to add to my relationship “polygamous.”
I am a man looking for a man
I am a woman looking for a woman
Are you looking for something serious or open to see where things will go ?
Yes, I’m looking for something serious .
No, just going with the flow.
Do you drink or smoke please be honest?
Both
Just Smoke
Just Drink
Other
Do you want to get married one day?
Yes
No
Would you consider yourself emotionally available?
Yes
No
Depends
Are you religious? Ie; Believe in the Lord Jesus Christ .
Yes
No
Would you date someone with a different religious belief ?
Yes
No
Do you believe in therapy? Have you been to therapy.
Yes
No
Yes & I have been to therapy .
Are you currently working or in school?
School
Working
Both
Entrepreneur
What is your yearly average salary
30k - 50k
55k - 70k
80k - 100k
6 figures and above
Would you date someone who earns less than you annually?
Yes
No
Depends
I’m a provider
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
State you live in
Please Select
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District of Columbia
Florida
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Height
Weight
Give a brief description of yourself
Describe an ideal date ?
Recent photo
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