Speed Dating
Questionnaire
Name
*
First Name
Last Name
Age
*
Gender Identity
*
Man
Woman
Non-binary
Other
Do you drink or smoke please be honest?
*
Both
Just Smoke
Just Drink
Other
Are you willing to contact the person you match with?
*
Yes
No
What Languages do you speak fluently?
*
Sexual Orientation?
*
Who are you interested in? ( Men, Woman, All Genders)
*
Preferred Age Range?
*
21 to 30
30 to 40
40-50
Other
Are you shy?
*
Yes
No
Would you like to receive a follow-up email with your matches?
*
Yes
No
Is this your first speed dating event?
*
Yes
No
Marital status
*
Single
Divorced
Widowed
Other
Deal Breakers or things you'd like us to consider while matching? (e.g, I don't want to date someone who smokes)
*
E-mail
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Give a brief description of yourself
Have you paid for your ticket?
*
Yes!
Not yet; Please email me other payment options.
No, Please send me the link.
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