Event Registration

Ice Breakers 101 registration form
First Name: _______________________________
Last Name: _______________________________
Phone: ___________________________________
Email: ___________________________________
Please have my matches contact me the following way:
Only by phone____ Only by Email_____ either by phone or email _______
What kind of single social events have you attended in the last two yrs?
How did you hear about us?
By signing this you understand that Ice Breakers 101 is not liable for anything that happens outside of this event. You will be dating at your own risk. You are giving us permission to give out your contact information to those you feel you have a connection with. Thank you for coming to Ice Breakers 101!