Submissive Application:
Mistress Emberly is currently accepting new submissives. To apply for consideration, fill out the form below in its entirety. Upon submission please allow up to 48 hours for response. Mistress Emberly will contact you via email to schedule a brief phone interview to discuss session and assess compatibility.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Company
Occupation:
Age
State
Preferred name for your mistress to address you:
Marital Status:
Why do you want to serve Mistress Emberly?
Interests & Fetishes you desire to pursue:
What are your limits:
Mistress attire you would like me to wear while controlling you:
Have you had experience with a Pro Domme in the past? If so, explain what you believe did/did not work. (If this is your first time in a D/S relationship, describe your ideal Domme in the space below):
List any toys you have at your disposal to play with (collars, gags, chastity cage, plugs, etc):
How would you feel about your mistress sharing photos/videos of you online for either humiliation or bragging purposes? (Identity always withheld and only referred to as your slave name of course):
This excites me
I prefer not
Any social media websites you use for d/s account purposes, please list below with username. (i.e.: Fetlife, twitter, etc.):
Preferred contact method:
Mistress Emberly does not provide sexual services. Do you accept this?
Please describe in detail the particular scene you are fantasizing about:
Anything I need to know? (Medical conditions, living arrangements, dependents such as children or pets, other concerns):
Are you aware that you may not demand anything sexual of Mistress Emberly, and that she will only show off her body if she desires to?
Yes
No
Are you aware that the evaluation/acceptance of your application is entirely up to the discretion of Mistress Emberly? I reserve the right to reject any application found unsatisfactory or undesirable.
Yes
No
References for at least 2 other pro-dommes who can vouch for you, along with a link to their website/contact info:
ID Photo: (if no references available, this is required. Address may be crossed out in photo however both name and birthdate must be visible. Skip this step if you have provided domme references).
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(Again only needed if no references available) Photo of business card for identity verification.
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How did you hear about Mistress Emberly?
Submit
Should be Empty: