Domme Session Application
**Read & Fill ALL Entries HONESTLY AND COMPLETELY** Intentional Submissions Only.
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Full Name
First Name
Last Name
File Upload
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Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Your Username
example (Twitter, Instagram, FetLife, SextPanther etc.)
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Tell me about yourself, what do you believe that I should know about you?
What are your desired kinks &/or fetishes?
What do you wish to explore with Goddexx Simone Reign? (Also specify online, in-person or FMTY)
What date and time work best for you?
Any other specific date and time, if the above selection is not suitable.
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Month
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Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
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References: *At least 3 Providers w/consent to reach out for confirmation*
Tribute is Required $75 feet. Current paylinks here: https://cash.app/$EyeKiko or https://venmo.com/u/Eye-Kiko510 **Priority goes to those who tribute!!** - Once sent, fill out in the box below “Tribute at Altar”.
Please await a response from Goddexx Simone Reign, within 2-3 business days or sooner.
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