Sunday 19th February 2012
20s & 30s Speeddating, The Hub, Cork.

Personal Details     

Please note: We very often publish some of your profile details on our website for upcoming events. Because of the very sensitive nature of this business and to maintain your anonymity we would prefer if you gave us a nickname. This will be used instead of your first name if we publish your profile.
Details shown are Nick Name, Gender, Age, Profession, Interests and County you reside in.
Personal details such as full name, mobile or email are never shown.

 
Booking Form
Nick Name

A value is required.* All marked with red star are obligatory.
Your nickname will be used instead of your 1st name. Preferably something interesting or amusing.
Date of Birth

A value is required. *
First name:
 A value is required. *
Surname:
 A value is required. *
Gender:
 Please make a selection. Please select an item.  *
Age:
 A value is required.*
Your age might be shown if we publish your profile on our website before upcoming events.
Email:
 A value is required.Invalid format. *
Telephone #1:
 A value is required. Numbers only (Mobile)*
Telephone #2:
 Numbers only (Landline) Optional
Profession:


Your profession might be shown if we publish your profile on our website before upcoming events.
Hobbies/interests. Likes/Dislikes and/or something different or interesting about yourself.


This might also be shown if we publish your profile on our website before upcoming events.
Please type in the names of the other applicants in your group. It helps to eliminate confusion.
Are you using someone else's credit card to pay?
 Please enter the name of the credit card holder here.
Where did you hear about us?
Method of Payment
 Please select an item.
What COUNTY (not country) do you live in?
  If you are you finished with the above applicant please hit the Submit button below
      (or Reset to clear your details & start again)