Long Distance Domination Before applying, read ABOUT page. Name * First Name Last Name City * Email * Phone (###) ### #### Preferred method of contact * Email Text Email and Text How did you hear about Me? * Do you have any prior experience with professional Domination? * Yes No What type of long distance dynamic are you looking for? * Financial Domination Key Holding Texting Photos Camming Other Please describe kinks/fetishes/interests/activities/desires that you wish to explore. * Soft and hard limits * Do you have any injuries, functional diversity, health conditions, allergies, phobias, or emotional triggers that I should know about in order to facilitate a safe experience for you? * If yes, please specify. You are 18 years or older. * Yes Mistress You understand that domination does not involve any unlawful act. I will not guarantee any specific plays, but will take your interests into consideration. Ultimately, do not forget that you are serving ME. * Yes Mistress You understand that this form does not guarantee any type of play until deposit/screening is complete. * Yes Mistress Your form has been submitted.