* 1. Your Contact Information

* 2. Who is accompanying you on this mystery date (please provide relationship and first + last name)?

* 3. When would you like to go on your mystery date (please select date at least 2 weeks from today's date)?

Preferred Day
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* 4. Specific Interests

* 5. Level of Activeness for Your Date

  Absolutely none No more than walking between locations Fair amount of activity I want to sweat Skydiving
Level of Activeness for Your Date

* 6. Price range (per couple)

* 7. What has been your favorite DC activity in the past 3 months?

* 8. Is there anything else you want to let us know (i.e. celebrations, dietary restrictions, time constraints, severe dislikes, etc.)?

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