**Our privacy is of the utmost importance. Your personal information be kept strictly confidential. Thank you for trusting me.

Should you have any issue submitting your form, please email directly with required info mademoisellenela@protonmail.ch

Full Name

First Name

Last Name

Nickname Nickname (or play name if you have one you like to use)

Email Address /Phone number

Age / Occupation / a bit about yourself / link to fully completed LinkedIn profile (if possible)

Preference

Date and length of requested rendezvous - include city

Provider reference

Where did you find me?

In a few words, tell me what prompted you to book and what are your expectations for our date.

What is / are your hobbies?

What's a a fun fact about you?

I acknowledge that a non refundable deposit will be needed to confirm our rendez-vous

**By booking, you confirm that you are of legal age in your jurisdiction and you fully understand that my fees are for my time only. Anything that may or may not occur is a matter of mutual choice between consenting adults; and you agree with my strict no reviews policy**

I do