"For Your Eyes Only" In-Person Private Dance Experience Request Form
A tribute is required for consideration. Min $35 via CashApp $theisyssdvine
Striptease Experience Custom-Tailored for Your Viewing Pleasure
$150/hr, $100/30min plus tips; Semi-Nude Please note this is simply a request form. You will be contacted via email for confirmation/location and additional information, if needed.
Legal Name
*
First Name
Last Name
Preferred Name
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Social Media Handle
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
How did you hear about me?
*
Referral
Event
Instagram
Other
Preferred date(s) & time(s): List at least 2
*
Desired Length of Session
*
30 min
60 min
90 min
Why did you choose me for this service?
*
What are your expectations for this session?
*
Desired Interaction Level
*
You want all of my attention
Acknowledge you occasionally
You just want to watch me
Any additional requests?
*
How do you define consent?
*
I understand that a tribute must be submitted and that this form must be completed in it's entirety to be considered for a session.
*
Yes
Submit
Should be Empty: