Please copy and paste into an email and return to Me, Mistress Kiva promptly for consideration.
 My email address is:

 Date/Time/Duration you are requesting an audience with your Mistress ___________________________________

 Name and last initial______________________



 Physical       Description_________________________________________________________________________________________________________________

 Marital Status__________

 Financial Status and Employment Industry________________________________

 Sexual Orientation__________________________

 Medical Concerns/Physical  Limitations_________________________________________________________________________________________________________________

 Phobias/Abuse Issues__________________________________________


 Can you be marked? If so, for how long?_______________________

 How often do you wish to visit with Me, (Mistress Kiva) Weekly? Bi-Weekly? Monthly?  Bi-annually?_________________________________

 Which attire do you prefer to see Me,(Mistress Kiva) adorned in? (Please choose all that apply and delete the rest).
 Latex dresses/skirts
 Patent Leather
 PVC/Vinyl pants/dresses/skirts
 Business attire/suits
 English riding apparel/boots
 Corsets/waist cinches

 Hosiery (please choose all that apply and delete the rest)
 Cuban heel/seamed
 Sheer black
 Nude pantyhose
 Black Knee-high
 Bare legs/none

 Shoes (please choose all that apply and delete the rest)
 Thigh-high boots
 Knee-high boots
 High-heeled pumps (closed toe)
 Peep-toe pumps or sandals (open toe)
 Platform heels
 Goth boots
 Goth Platform shoes

 Gloves (please choose all that apply and delete the rest)
 Latex (opera length)
 Leather (wrist length)
 Satin (opera length)
 Bare arms/none

 In regard to My demeanor during the session, (i the submissive, would prefer:) (please choose all that apply and delete the rest)
 Spoiled/Never satisfied

 What best describes your reason for visiting Me? (please choose all that apply and delete the rest)
 Suffering to please your Mistress and amuse Her (with disregard to my desires)___________________
 Exorcism of guilt_____________
 Other(please describe)_________________________

 What would best describe the scenario you are seeking? (please choose all that interest you and delete the rest)
 Schoolteacher/naughty boy
 Female pimp/man-whore
 Riding Mistress/ponyboy
 Blackmailer/financial slave
 Humiliatrix/small penis man
 Mommy/Little boy
 Other (please  describe)____________________________________________________________________________________________________________________________

How long have you been involved in BDSM activities?_________

 Do you have any other skills outside slavery that you can offer Me? How will you please your Mistress other than Her required   tribute? __________________________________________

 Do you have references from other Dommes (local,national or international)?__________________

 Are you involved in any fetish/BDSM organizations? If so,  which?_______________________________________________________

 ACTIVITIES I AM INTERESTED IN: (please choose all that apply and delete the rest)
 1.Bondage: Leather, Rope, Bondage tape, Saran wrap
 Method: Light, Inescapable, Extended, Mummification

 2.Corporal Punishment: Flogging, Whipping, Strapping, Spanking, Caning, Birching, Hairbrush

 3.Genital Torture: Whipping, Chastity, Kicking/Kneeing,Trampling, Stretching/Weights, Chastity, Light touch cigarette, Hot wax, tight bondage/tying, manual squeezing/vise, slapping

 4. Foot Worship: Stocking/Pantyhose, Shoe/Boot/Heel, Bare Feet
Method: Bootlicker, Toe Kisser, Masseuse, Footstool, Rug

Method: (please describe)____________________________________

 6.Domestic Service Training (must be available with 2-8 hours notice): Chambermaid, Chauffeur, Foot slave, Dungeon Slut (forced-bi fantasy)

 7.Shaving (yes, no or choose): Genital area, Body_____________

 8.Smoking Fetish (Mistress smokes. Yes or No): Human Ashtray Service______________

 9.Puppy Training (yes or no): Caging, dog food eating, leash training, costuming, verbal command training

 10.Pony Training (yes or no): Show pony, cart pony, riding pony

 11.Financial slave/Paypig/Blackmail (yes or no)___________

 12.Cuckolding/Key-Holding CB-3000/6000/The Curve Long or short duration training

 I love to entertain My guests. Are you comfortable being in a session/scene/show/party, with others:

 Dominant Females
 Dominant males
 Submissive Females
 Submissive males

 Confidentiality is of supreme importance to Mistress Kiva. I may use Masks to hide your identity.