COURSE APPLICATION

COURSE APPLICATION
The Basics
Name *

First Name Last Name
Age *
Must be 21+
Email *
example@example.com
Secondary Email (Optional)
example@example.com
Primary Phone Number *
Please do not use VoIP or text apps such as Google Voice
Secondary Phone Number (Optional)
If you prefer to be contacted on a different number than your primary phone number, please use this field.
City & State of Residence *

Street Address

Street Address Line 2

City State / Province
I would like a reply via... *

Email Text Either/No Preference
I found you on... *

Tryst.link Twitter Eros Instagram Slixa Private Delights RS-AVS Other
Other *
Screening Information
I will be using the following screening method: *

ID Verification Employment Verification Student Verification RS-AVS Membership References
Student Verification

Please provide your student ID and student .edu address below
Student Email *
example@example.edu
Please Provide a Copy of Your Student ID Here *

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Cancel of
ID Verification

Please provide a copy of a government issued ID in the field below, such as a driver's license, state ID card or passport. For your privacy and safety, you may cover/black out information such as your license number, social security number and your full address. Just your name, birthdate and city/state need be visible.
Please Upload a Copy of Your ID Here *

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Cancel of
References

Please provide two recent references from the past six months or three from the past year in the fields below. Include their names, websites, ads and/or social media links along with where and approximately when you last saw them (a city and month/year is fine). I only accept references from independent providers. Agency references will not be accepted.
Reference #1 *
Reference #2 *
Reference #3
Employment Verification

Please provide at least two of the following options
LinkedIn Or Personal Listing on Your Company's Website *
Direct Company Email
Direct Phone Number (include extension if applicable)

Area Code Phone Number
RS-AVS Membership
Is Your RS-AVS membership Information the same as the information listed above? *

Yes No
Please list your RS-AVS information here *
Additional Screening Information (Optional)

While not mandatory, if you have any additional information that would be helpful you are welcome to provide it here. Examples include links to social media (Facebook, Twitter, Instagram, etc), personal websites, Preferred 411 number or Private Delights profile.
Appointment Details
I am looking for an appointment that is... *

Chicago Based Incall Schaumburg Based Incall Chicago Area 3+ Star Hotel Outcall (+$100-$200 depending on location) Touring Incall Touring 3+ Star Hotel Outcall (+$200) Fly or Drive Me To You
Where Would You Like To Meet? *
City/State
When Would You Like to Meet? *

Month Day Year
Please provide at least 24 hours notice
What Time? *

: Hour Minutes AM/PM Option
Length *
Is this date/time flexible? *

Yes No
Please Use This Space to List Alternate Dates and Times
All About You!

The fun but totally optional part!
Tell Me A Little More About You!
If there's anything you'd like me to know about you, please do share! This can also include any pertinent health information (ex any disabilities you may have)
Educational Addendums
If you have any areas of study that are of particular interest to you, or you have any particular requests (ex adding 420 to our course) please share here!
Your Favorites & Hobbies
Ex: Favorite books, movies, music, food, drinks, etc
Deposit, Cancellation and Rescheduling Policies *

I have read, understand and accept Professor DeMilo's deposit, cancellation and rescheduling policies.
Should be Empty:

COURSE APPLICATION

The Basics

Screening Information

Student Verification

ID Verification

References

Employment Verification

RS-AVS Membership

Additional Screening Information (Optional)

Appointment Details

All About You!