Speed Dating Sign Up Form

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Where: April 25th, 2026 from 6PM-9PM

Where: Zembrodt Education Center (3rd floor)

104 W. Pike St. Covington, KY

First and Last Name:

Email Address:

Phone Number:

Date of Birth:

YYYY

What is your gender identity?

Female

Male

Other

Clear selection

Who are you interested in meeting at this event?

Women

Men

Women and/or men

other

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Will you be bringing a friend or support person to the event?

(note: one guest per person is welcome and there will be a separate area and an optional engagement activity for guests)

Yes

Clear selection

Are you your own guardian or do you have a legal guardian?

I am my own guardian.

I have a legal guardian.

Clear selection

Please list a few of your interests.

Tell us about yourself (optional).

Please feel free to give a short bio about yourself and your goals for this event.

Please list allergies (snacks and beverages will be provided).

Submit

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