Clone of 2022 Speed Dating Registration Form

SVAJAN - Speed Dating Registration Form

[Open to any Gujarati candidate. $65 per registration. On Nov 15, 2025, 10am, at Lake Chateau Banquets, Woodbridge, NJ]
Full Name*

First NameMiddle NameLast Name
Father's Name*

First NameMiddle NameLast Name
Mother's Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
E-mail*
Height*
Weight*
Gender*

MaleFemale
Birth Date*

MonthDayYear
Place of Birth*
Samaj Name*
Education/Degree*
Year Graduated*
University*
Occupation*
Current employer*
Marital Status*

Never marriedDivorced
Citizenship*

US CitizenGreen CardH1 VisaStudentOther
Hobbies*
Partner Preferences*
(Example: Age range, Diet, Citizenship, Education etc.)
Upload Photo*

Upload a File
(request to upload headshot picture) Cancelof
PAYMENT: (note: your entry is not valid without payment)

Option1: Zelle $65 using svajanmain@gmail.com (Make sure to put Note/Memo, name of the candidate and phone number for contact. Your payment will not be considered without that. )

Option2: PayPal link can be clicked to pay via PayPal, you can use any credit card also (doesn't required to have PayPal account). it will have convinience fee.
Agree to the term*

You will pay $65 donation per entry to complete the registration. This registration and data collected is for one particular event only. SVAJAN will not be responsible for any damages or loss during or after the event.
Should be Empty:

SVAJAN - Speed Dating Registration Form