Appointment Request
Preferred day & time?
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Month
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Day
Year
Date Picker Icon
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Hour
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30
Minutes
AM
PM
AM/PM Option
Duration
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1 hour
90 minutes
2 hours
3 hours
4-5 hours
6-7 hours
12 hours
24 hours
Other
Alternate day & time if above is unavailable
Location: CITY and/or hotel
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Full Name
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First Name
Last Name
Suffix
Phone
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Area or Country Code
Phone Number
OK to call and/or text?
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Yes, either is fine
Phone call only
Texts only
Neither
M-F 9-5 only
Other
E-mail
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Resident city & state or country
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Self description - age, appearance, hobbies, etc:
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Occupation:
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Name on Adult Message Board and/or Social Media (Twitter, Private Delights, etc)
Screening Information: Option 1: Member of P411 or RS2K. Option 2: TWO established internet companions that you have seen. Option 3: Work contact info (email preferred). Option 4: Other - some way to prove who you are (this can NOT be done in person).
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Which website did you find my ad on?
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Submit
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