Application to Surrender

Surrender

to Mistress Alice
Your Name

FirstLast
Email
Phone Number
Age
Occupation
Personal Introduction
Tell me about yourself - What are your hobbies & interests? Tell me about your appearance. Perhaps tell me an interesting fact about yourself. What are your favorite bands/books/tv shows/movies? This is one of the most important boxes on this form. This is your main opportunity to catch my eye.
How did you discover Me and why do you wish to serve Me?
Experience
Tell me about your previous BDSM experiences.
Session Desires
Describe your ideal session.
Session Limits
List any activities you are not interested in exploring under any circumstances. Include any trigger words.
Physical Limitations
Include any relevant medical history & conditions (STD's, surgeries, history of heart attack/stroke, nerve damage, implants, pacemaker, areas with chronic pain, diabetes, latex allergy, etc.) Do you have trouble standing for periods of time?
Desired Session Length

	Light	Medium	Intense	Unsure	Not Interested
Corporal Punishment & Impact Play
Bondage
Humiliation
CBT
Nipple Torture
Posterior Play

Impact Play

Bare PalmGloved PalmRiding CropFloggerPaddleHairbrushCaneWhipI consider myself a masochist
Areas to focus on
Areas to avoid other than the obvious (kidneys, neck, etc.)
Impact Play Comments
Bondage

Collar & LeashPosture CollarWrist & AnkleCockBallsExtremetiesBlindfoldHoodGagRopeMetal RestraintsChastityTapePredicament BondageBody BagSensory DeprivationMumification
Bondage Comments
Humiliation

Name CallingDegredationObjectificationSissificationCostumingLipstick/MakeupSmall Penis HumiliationFoot/Boot/Heel WorshipPet PlayHumiliating TasksDeep ThroatingFace SlappingSpittingIgnoringTauntingGSForced Cum EatingHair PullingBeing WatchedForced Bi
Favored Words/Names
Humiliation Comments
Cock & Ball Torture

ClothespinsClamps/More Painful ImplementsHot WaxSmackingFloggingCroppingCanningSteppingCrushingKickingElectro PlayWartenberg WheelStretchingWeightsTease & DenialRuined OrgasmChastity Cage
CBT Comments
Nipple Torture

FingersClothespinsClamps/More Painful ImplementsHot WaxWartenberg WheelStretchingWeightsElectro PlayFloggerCrop
NT Comments
Posterior Play

Small ToysMedium ToysLarge ToysExtra Large ToysFingersPlugsVibratorsStretchingFisting
Posterior Play Comments
Marks

No marksMarks/redness that last a dayMarks that last for several daysHeavy markingMarks are okay if they can be covered by clothing
Roleplay
Describe your roleplaying fantasies, if any.
Session Photography

No photosPhotos for personal use only are okayDiscreet photos may be posted online (no distinguishing features)All photography may be published online
References
List at least 2 Providers you have seen before. Include each Providers name & website. If you do not have any references, you must provide photocopies of your ID and/or a valid LinkedIn page. You may add your LinkedIn page to the box above. If submitting your ID for screening, I will let you know how/when to submit it at a later time through email.
By checking each box, I agree that:

I am over the age of 18.I understand that Domination does not involve/imply sex or any illegal activity.I will not ask Mistress Alice to engage in any play not outlined in this formI have included references or a link to my LinkedIn page or will provide a photocopy of my ID when Mistress Alice requests it later on.I consent to having this website store the information that I have submitted.
After submitting this form YOU MUST send an email to mistressalicelynch@protonmail.com letting me know you completed this form. This will help prevent any correspondence from me going to your spam folder.

If you are requesting a same day appointment, please title your email SAME DAY APPOINTMENT REQUEST.

Priority is given to those who give thoughtful answers and follow all of my instructions. If you do not receive a reply within 72 hours, I was likely unimpressed and chose not to respond.
Should be Empty: