BLIND DATE: Reservation Form

■Reservation Form:

Please fill in the Reservation Form below. Please make sure that all information submitted is accurate as we will use this to contact you regarding any changes or updates to the event(s).

In case you do not receive our confirmation email within a week, you may have mistyped your email address in the form. Please contact us.

* We will not disclose your personal information to any other third party.
* Fields indicated with an asterisk (*) are mandatory.

Date of Event*
First Name*
Last Name*
Gender*	Male / Female
Contact phone number*	*This will be the contact phone number for your matches.
Email*	This will be the contact address for your matches. For Yahoo account users, please make sure to register info@blinddate.jp or provide other account.
Re-enter Email*
Nationality*
Age*
Verify* 3x3=?
How did you find us?
Inquiry/Comment

■Cancellation Policy

Our unique event format requires us to limit attendance and balance our events with equal numbers of men and women. Please realize that planning a blind date event is a time-consuming process and we work very hard at making everything perfect. NO-SHOWs are discourteous to say the least! Please do not become a NO-SHOW. Most events fill up and a waiting list is formed. If you cannot make it to the event, please let us know ASAP (at least a week in advance) so we may select someone from the list to take your place. Thanks.
No-show will cause all the participants trouble, therefore you will not be able to sign up for the future events in case you do not let us know in advance.