Geek Dating Mixer

 
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1. What is your first and last name?
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2. What is your email address (so we can contact you if we move forward with another mixer):
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3. How old are you?
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4. What Meetup Group to you belong to? If more than one, choose the one you are most active with:
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5. What is your gender?
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6. Who are you interested in dating? Select all that apply.
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7. What is your relationship status?
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8. What are you looking for? If more than one, choose the option that best fits primary goal.
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9. Do you have children?
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10. Please provide a link to a current photo of you (meetup or other public page):
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