• 

• Application

• Name *
  First Name Last Name
• Gender *
  Male Female
• Email *
  
  Confirmation Email This will be used to communicate with you about your application
• Age: *
• Phone Number (optional)
  - Area Code Phone Number
• Experience Level *
  Newbie Some experience Very experienced
• Can you leave with marks? *
  No - I cannot leave with marks Yes - Light marks that will disappear within a few hours Yes - I can have marks that are covered by clothing Yes - Mark me as You please Marks refer to scratches, singletail, viper, or cane marks. Not just a red area
• Room Preference (optional)
  No preference Dungeon Sensation Room Medical Clinic Classroom
• List of potential experiences: *

  	No / Hard Limit	Take it or leave it	Interested / Want to try	Yes / Love it
  Anal stimulation
  Arm binders
  Blindfolds
  Bondage
  Breast / nipple torture
  Breath control
  Caning
  Chastity
  Cling / plastic wrap
  Cock & ball torture
  Collar & leash training
  Confinement / caging
  Cross
  Cross dressing
  Cupping
  Depilation / shaving
  Discipline
  Doctor / patient
  Electric play
  Floggers
  Foot fetish
  Hair pulling
  Hoods
  Humiliation
  Over the knee spanking
  Paddling
  Pinching
  Sensory deprivation
  Single tail
  Sounds
  Straight jacket
  Strap-on (not available on first visit)
  Tickling
  Vacuum bed
  Violet want
  Wooden toys

• Describe a scene based on your selections from above: *
• List an medical conditions (including medications):
• Submit
• Should be Empty: