Plan My Date

Date Your Way launches January 2011!

Please answer the following questions to assist the date coordinator in creating and customizing your date options. All answers are confidential.

Name:
Email Address:
1. What type of date are you seeking (romantic, adventurous, it does not matter)?
2. Is this a special occasion (birthday, anniversary, proposal, etc.)?
3. What date (if applicable) and/or time of day are thinking of (ie. Friday evening, weekend trip, daytime Saturday, Sunday brunch)?
4. What are the interests of the two of you, for the date?	Fine dining Dancing Sports/recreation Shopping Weekend trips Family-oriented
5. Do you have food preferences (Mexican, Asian, Italian, etc.)?
6. Please describe your last date with this person. What were your likes/dislikes?
7. What is an estimate on how much you plan on spending?
8. Zipcode?
9. Are there any restrictions (i.e. back problems, pregnancies, handicaps, etc.)
10. How did you hear about us?
If other, please specify:
11. Are you interested in becoming a member of Your Date Your Way?

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