Potential Participant Survey

To participate in the Axios Blind Date program, you must be over 21, single, and live in Charlotte. By filling out this form, you agree that we can use this information when we publish a story. To go on a Blind Date, you must agree to have a story written about your date, and you must agree to a phone interview after the date. Read our Privacy Policy and Terms of Use. 

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* 1. Are you willing to share a photo of yourself and your first name as part of the series?

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* 2. First Name

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* 3. Last Name

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* 4. Age

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* 5. With which gender identity do you most identify?

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* 6. Do you date:

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* 7. Your Height

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* 8. Your Job:

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* 9. Favorite weekend hobbies or activities?

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* 10. Describe yourself in a single sentence:

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* 11. What's your type? Be as detailed as possible. 

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* 12. Why should we select you?

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* 13. Profile Photo

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File

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* 14. Additional Profile Photo

DOCX, DOC, JPG, GIF, JPEG, PDF, PNG file types only.
Choose File

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* 15. Your email address and phone number:

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