* 1. Your Contact Information

* 2. Who is the Mystery Date for?

* 3. On which day would you prefer to go on your Mystery Date (please select date at least 2 weeks from today's date)?

Preferred Day #1
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Preferred Day #2
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Preferred Day #3
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* 4. Level of Activeness for Your Date

  None A little Medium A lot Skydiving
Level of Activeness for Your Date

* 5. Specific Interests

* 6. Price range (per couple)

* 7. Duration

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

* 9. Are you celebrating anything specific?

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

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