I want to participate in a BLIND DATE ON STAGE September 12th
You will be onstage, blind folded, chatting and flirting with another single, in front of the crowd. You will then have the opportunity to THUMBS UP or THUMBS DOWN on proceeding to a date night, ON US! Our goal is to match couples that will truly connect. Fill out the form below and we will work to find the best matches from those that applied. THESE ANSWERS WILL NOT BE SHARED WITH YOUR MATCH. FOR INTERNAL USE ONLY.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Age (for blind date matching purposes)
*
Height (for blind date matching purposes)
*
I am interested in matching on stage with:
*
Man
Woman
Anyone
Current job:
*
Social media link:
*
Social media link:
Photo of you
*
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Photo of you
*
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Choose a file
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If chosen, you will be on stage in front of hundreds of singles. Entrants to the event are not back ground checked. Queenie Be and The Momentary are not responsible for and assume no liability for any interactions, communications, or relationships that occur before, during, or after the event. Do you agree to this?
*
Yes
No, and I recognize this disqualifies me from being picked as a single.
We will release the photos of some of the singles on social media, to promote the event, for these posts YOUR NAME OR IDENTIFYING DATA WILL NOT BE USED IN THESE POSTS. If selected, at the event YOUR FIRST NAME WILL BE USED ON STAGE. Your social media tags, contact info, last name, place of work or other identifying information will not be used. Are you ok with this?
*
Yes
No, and I recognize this disqualifies me from being picked as a single.
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