Madame Aza
Submissive Application (Serious Inquiries Only)
What is your name/what would you like to be referred to as?
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(Ex. Beta, Sissy, Pet, etc.)
Best way to contact
(Ex. Text, Call, Email)
Location
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You must be over the age of 18
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Browse Files
Upload your Identification Card or Driver's License (This is to ensure the safety and protection of the Madame. No far away or blurry shots. You may REDACT as much information as possible, but a live in hand ID photo is required)
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Do you understand that there is NO sexual activity involved during a session with Madame Aza?
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Yes
No
Why are you interested in Madame Aza?
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How many years of experience do you have as a sub? Do you have reference from other Dommes?
How much control do you want over your daily life?
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Are you looking for:
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Long Term
Short Term
How do you prefer your Domme to treat you in session?
Humiliating
Sensual
Bratty
Sadistic
Strict
Ruthless
Nurturing
What are your kinks?
Cock and Torture
Foot Worship
Face Smothering
Sissy Training
Pet Play
Wax Play
Impact Play (flogging, paddle, whip, open hand)
Pegging
Chastity
Humiliation
Nipple Toture
Tickling
Sensation Play
Sensory Deprivation
Voyerurism
Tools Desired
Flogger
Whip
Paddle
Dress/Makeup/Heels
Collar
Leash
Mouth Gag
Blindfold
Chastity Cage
Handcuffs
Crop
Ball Crusher
What is your pain level?
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Light
Moderate
Intense
Extreme
Any physical limitations?
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Yes
No
If Yes, what are they?
List your soft and hard limits
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How much can you tribute and how often?
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What kind(s) of session are you interested in?
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In Person
Online/Virtual
Both
Are you comfortable with pictures or videos taken during a session? If masked or identity is concealed.
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Yes
No
If you are ready to serve Madame Aza, send the $50 Application Fee
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By signing this document, you agree that all transferred or received funds are consensual, non-refundable and in agreement with both parties.
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Last Name
Credit Card Number
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