Dateology - The Science of The Connection

Dateology - The Science of The Connection

Full Name :*

Email Address : *

Birthdate : (MM/DD/YYYY)*

Address :*

County You Live In :*

Age Range (Choose One) :*

18-25

26-35

36-45

46-55

56+

Occupation / Field of Work :*

Annual Income Range (Optional) :

Under $30k

$30k - $50k

$50k - $75k

$75k - $100k

$100k - $150k

$150k+

Prefer Not to Say

Do You Have Pets? (You Can Select Multiple)*

None

Dog

Cat

Other : ________________________________

How Close are You with Your Family?*

Very Close

Somewhat Close

Not Very Close

Not Involved

Prefer Not to Say

Religious or Spiritual Beliefs (Optional) :

Communication Style :*

Direct

Warm & Friendly

Reserved

Analytical

Balanced

Social Comfort Level :*

One-on-One

Small Groups

Large Groups

Prefer Online First

Energy Level :*

Low-Key

Balanced

High Energy

Depends

Goals At this Event :*

Networking

Friends

Mentorship

Dating Interest

Collaboration

Exploring

Children (Optional) :

Yes

No

Living at Home

Perfer Not to Say

Personality Type :*

Introvert

Extrovert

Ambivert

Relationship Satus (Optional) :

Single

In a Relationship

Married

Divorced

Prefer Not to Say

Gender Identity (Optional) :

Woman

Man

Non-Binary

Self-Described

Prefer Not to Say

Interested in Connecting with (Optional) :

Woman

Men

Non-Binary Individuals

All Genders

Prefer Not to Say

Sexual Orientation (Optional) :

Straight

Gay

Lesbian

Bisexual

Pansexual

Queer

Questioning

Prefer Not to Say

Other : ______________________

Deal-Breakers or Boundaries (Optional) :

Qualities You Value in Others :*

Honesty

Ambition

Humor

Loyalty

Emotional Maturity

Faith

Other : ___________________________

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