gay speed dating application form

On receipt of your Application Form and Payment of AU$82.50 (inclusive of G.S.T), you will be enrolled in an upcoming Perfectdates Speed Dating Evening.
As numbers are limited for each event, register now to be part of the Ultimate Dating Experience.
If you do not wish to submit this form electronically, please print it out and post to 22 Pender Street Thornbury Vic 3071.
Alternatively contact us if you would like us to send or email you a copy of the application form.

To read our Privacy Policy.

Please fill in ALL entries in the form that apply to you.

Is this Application for you or for a friend?

Myself Friend

If this application is a Gift Certificate for a friend please fill in the friend's contact details below. Or if this is for you, click here.

My Friend's First Name

My Friend's Last Name

My Friend's Address

My Friend's Suburb

My Friend's Telephone

My Friend's Mobile

My Friend's Email address

And please fill in your own details below.

My First Name

My Last Name

My Address

My Suburb

My Telephone

My Mobile

My Email

Please fill out ALL details below, or fill out your friend's details if the Application is for a gift. Entries marked with a * are required fields.

Which of the above is the best way to contact you? *

Date of birth *

Sex *

M F

Job *

What type of event do you want to be involved in? *

Heterosexual Gay

Do you have kids?

What do you do with your free time and why? *

How would you describe yourself? *

Describe your ideal date *

Additional Comments
(e.g. your available dates or times, etc)

 


Which event would you like to register for:

Speed Dating ($82.50 inc gst)

I agree in submitting this form that I am single and will represent myself in an honest manner and have read and understood the terms and conditions as listed below.

     

terms and conditions

  • You will be contacted with details of upcoming Perfectdates events within five working days of receipt of your application form and payment.
  • Perfectdates is not a Dating Agency, so we can't guarantee that you will meet your dream date, but we know that you will have the time of your life looking.
  • Perfectdates takes no responsibility for the activities of its participants, nor of its participants at consequential meetings and reserves the right to refuse entry to any drunken or disorderly person.
  • The information supplied to Perfectdates will be kept confidential and will not be passed onto a third party without your prior consent.
  • For security reasons, photo identification will need to be supplied on the night if payment has been made by credit card.

cancellations

  • Cancellation within seven days of a confirmed booking- no refunds will be given.
  • Cancellation received prior to this full refund minus administration fee of $20 given.

contact details
address:

22 Pender Street
Thornbury Vic 3071
tel:

03 9863 7633
fax:

03 9443 7576
mob:

0402 517 516
email:

enquiries@perfectdates.com.au
website:

www.perfectdates.com.au

 

ABN: 88 214 814 439